Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries
Open accessAbstract
Objectives: To assess the effects of costs on access to medicines in 11 developed countries offering different levels of prescription drug coverage for their populations. Design: Cross-sectional study of data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults. Setting: Telephone survey conducted in 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA. Participants: 22 532 adults aged 55 and older and living in the community in studied countries. Primary outcome measure: Self-reported cost-related non-adherence (CRNA) in the form of either not filling a prescription or skipping doses within the last 12 months because of out-of-pocket costs. Results: Estimated prevalence of CRNA among all older adults varied from <3% in the France, Norway, Sweden, Switzerland and the UK to 16.8% in the USA. Canada had the second highest national prevalence of CRNA (8.3%), followed by Australia (6.8%). Older adults in the USA were approximately six times more likely to report CRNA than older adults in the UK (adjusted OR=6.09; 95% CI 3.60 to 10.20). Older adults in Australia and Canada were also statistically significantly more likely to report CRNA than older adults in the UK. Across most countries, the prevalence of CRNA was higher among lower income residents and lower among residents over age 65. Conclusions: Observed differences in national prevalence of CRNA appear to follow lines of availability of prescription drug coverage and the extent of direct patient charges for prescriptions under available drug plans.
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High prices are barriers to access to medications, particularly for antiobesity medications.
“It is well established that high prices are barriers to access to medications, particularly for AOMs [12].”
From Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment (2023) · cites this paper as [12]
The Introduction says costs are a common cause of prescription non-adherence, and the Conclusion associates higher patient costs with greater risk of access barriers. The paper studies prescribed medicines among older adults generally; it does not establish that the barrier is particularly pronounced for antiobesity medications. (LLM, conf=0.88)
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- Authors
- Morgan, S. G., & Lee, A.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Morgan, Steven G
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-01
- Volume
- 7
- Issue
- 1
- Pages
- e014287
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5293866
- OpenAlex
- W2583329548
- Cited by
- 112
- References
- 16
- Citations by year
- 2026: 1 · 2025: 12 · 2024: 5 · 2023: 16 · 2022: 12 · 2021: 17 · 2020: 20 · 2019: 13 · 2018: 7 · 2017: 9
- FWCI
- 24.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Commonwealth Fund (20160646)
- Institute of Gender and Health (DCO150GP)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- cost-related nonadherence, medication adherence, older adults, prescription drug coverage, out-of-pocket costs, access to medicines, income inequality, cross-national comparison
- MeSH terms
- Assessment of Medication Adherence, Aged, Australia, Canada, Cross-Sectional Studies, Europe, Health Expenditures, Female, Humans, Income, Insurance, Pharmaceutical Services, Male, Middle Aged, New Zealand, Surveys and Questionnaires, United States, Drug Monitoring, Cost of Illness, Developed Countries, Insurance Coverage, Universal Health Insurance, Medication Adherence, Prescription Drugs
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