Americans are more than five times more likely to skip medication doses or not fill prescriptions due to cost than peers in the United Kingdom or Switzerland. U.S. patients are twice as likely as Canadians to avoid medicines due to cost. And, compared with health citizens in France, U.S. consumers are ten-times more likely to be non-adherent to prescription medications due to cost.

It’s very clear that more consumers tend to avoid filling and taking prescription drugs, due to cost barriers, when faced with higher direct charges for medicines. This evidence is presented in the research article, Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries, published in BMJ Open journal this week.

The pill-bar chart illustrates the big difference between U.S. patients and health citizens living in other wealthy countries including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the UK. Dr. Steven Morgan, professor of health policy at the University of British Columbia, and student researcher Augustine Lee, studied self-reported cost-related non-adherence (CRNA) patterns across the eleven countries using data from The Commonwealth Fund’s 2014 International Health Policy Survey of Older Adults, which focused on people aged 55 years and over. Among the 11 nations, 9 provide health citizens comprehensive universal health care coverage which includes prescription drug coverage. Canada (the tenth country) covers health care universally, but residents may not have access to drug coverage which can vary by patient age, occupation, income, and province of residence.

Among the eleven developed countries studied, the U.S. is the only one which does not offer universal coverage for healthcare services, nor pharmaceutical coverage. When a U.S. health citizen reaches the age of 65, they are then covered for the Medicare Part D drug benefit.

The chart, based on the Fund’s survey data, illustrates that the U.S. had the highest level of Rx non-adherence in 2014, followed by Canada.

The bottom-line, the authors write: “CRNA is inversely related to the extent of drug coverage available.”

Health Populi’s Hot Points:  Consumer-directed health plans in the U.S. are designed to give consumers more financial “skin-in-the-game.” The theory behind CDHPs is that having a financial stake in health care decisions will incentivize and motivate patients to behave as consumers who shop for healthcare services and products.

When it comes to prescription drugs, there is a level of transparency at the point-of-purchase, in the form of a price paid at the pharmacy, or for mail-order medicines that address peoples’ chronic conditions. There are apps like GoodRx that help people find the best price for a particular drug in their community (or for a generic equivalent), and even drive a digital coupon to that patients’ smartphone for a discount on the retail price of the drug.

The BMJ Open study reveals that, by 2014, consumers 55 and over were still not behaving in ways that were clinically responsible. Some portion of 16.3% of health citizens in American were self-rationing prescribed drugs due to cost, going against their doctors’ (or prescribers’) recommendation because of money.

This week, as President Trump met with leaders of many of the nation’s largest pharmaceutical manufacturers, he talked about reducing regulations for time-to-market of new medicines, reducing the costs of doing business especially tax rates, and even the possibility of compelling foreign nations to pay for drug development costs borne by U.S. firms.

This was more a jobs message than a cost-control message. The President didn’t use the “M” word in this meeting as he did in his interview as TIME magazine’s Person of the Year, claiming these same companies were committing “murder” due to their Rx pricing strategies. He did not push the concept of directly negotiating with the companies for products covering Medicare and Medicaid, a strategy that was included in his campaign platform before being elected President.

The evening of this meeting, I saw, for the first time, a broadcast commercial during the six o’clock news hour on cable TV, featuring PhRMA’s new ad campaign to promote the pharma industry’s role in making consumers’ lives better by not going gently into that good night. It’s a beautifully-produced launch. Here’s the video.

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