People who have to pay less for their medicines are more likely to take them, says a review of several earlier studies. The research review focused on a widespread problem. Studies show that about half of U.S. patients don't take their medicines correctly for long-term conditions such as high blood pressure and diabetes. Up to 30% of prescriptions are not even filled. All of this is estimated to contribute to 125,000 deaths each year. Researchers reviewed several dozen studies. Five studies found that people were more likely to take their medicines if their drug coverage improved or their out-of-pocket costs went down. Educating patients and trying to help with problems that were keeping them from taking their medicines also helped. So did personal contacts from a nurse for people with a high risk of not taking all medicines. The journal Annals of Internal Medicine published the study online September 10. Reuters Health news service wrote about it.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

People with long-lasting conditions like high blood pressure, high cholesterol and heart disease need medicines to treat those conditions. But up to 50% don't take their medicines as they should. As many as 30% don't even get their prescriptions filled.

Those who do have the pills in the house often skip doses. Others stop for some reason and don't restart one or more drugs.

Not taking all prescribed medicines for long-lasting conditions is linked to poorer health and much higher health costs. The result could be a stroke, heart attack or hospital stay for heart failure. Any of these would cost much more, in personal and financial terms, than taking medicines for several years.

Researchers have tried for years to find ways to increase the number of patients who take all of their medicines. Authors of the most recent analysis reviewed many prior studies that looked at this question. The journal Annals of Internal Medicine published their findings online September 10.

The authors suggest three potential solutions:

• Lower out-of-pocket costs for drugs.
• Provide frequent contact by a nurse or other member of the doctor's team.
• Provide patients with very specific advice on how to take medicines properly. Make sure the language is easy to understand.

Of these three, lowering out-of-pocket drug costs appeared to be the most consistent way to improve how many people take their medicines as prescribed.

What Changes Can I Make Now?

For many long-lasting conditions, the best way to reduce your drug costs is with lifestyle changes. These changes can reduce how much medicine you need for conditions such as high blood pressure, type 2 diabetes and high cholesterol.

Here's what you can do:

• Keep your body weight in check.
• Eat a healthy diet.
• Stay physically active and exercise daily.

With lifestyle changes, you may be able to lower the doses of drugs you need. And possibly you can eliminate one or two of the drugs.

Here are some other things you can do now to help reduce how much you pay for your drugs:

• Choose the generic version when available.
• If no generic version of a drug is available, ask your doctor if a different medicine that costs less might work as well for you.
• If you have a drug benefit plan, ask your doctor to prescribe drugs from the plan's preferred drug list whenever possible.
• If you take prescription drugs that you know you will need for a long time, think about getting a three-month supply at a time. This may lower how much you pay under your prescription plan.
• Consider using a mail-order pharmacy. If your pharmacy is Internet-based, look for a Verified Internet Pharmacy Practice Sites (VIPPS) seal of approval.
• Ask your pharmacist if your pills can be split. Your doctor can prescribe double the strength of your drug. Then you can split the pills and take half at a time. This sometimes can reduce your cost by as much as one-half.

If you are unable to pay for all of your medicines each month, let your doctor know. He or she may know of some way to get financial help. Also contact the drug company that makes your medicine. You could be eligible for a drug company program.

Don't just stop taking your medicines. If you can't afford all of the ones prescribed, ask your doctor which ones are most important for you.

What Can I Expect Looking to the Future?

In recent years, generic versions have become available for many of the most commonly needed drugs. This has greatly decreased costs for these drugs. For example, there are now several generic statin drugs to lower blood cholesterol.

Drug costs for common long-lasting conditions are likely to fall a bit more during the next few years.