Patients receiving free or low-cost medications may not stick to their prescription perfectly, but they’re not much different than patients with insurance, according to a study from the University of North Carolina at Chapel Hill.
UNC researchers studied patients enrolled in the UNC Health Care Pharmacy Assistance Program from 2009 through 2011 who received medication for high blood pressure, diabetes, or high cholesterol. The program provides free or reduced-cost medication to low-income patients.
“Low-income patients who have chronic diseases but not insurance have a difficult time getting medications reliably, which often leads to serious, unnecessary, and costly health problems,” says Drew Roberts, PharmD, a researcher at the UNC Eshelman School of Pharmacy and the study’s lead author.
“We demonstrated that when uninsured North Carolinians are given access to medicines for chronic diseases through the PAP, they will take those medicines about as well as patients with insurance do.”
Aiming for Eighty
The study set the bar for optimal adherence at 80 percent, meaning patients took their medications as directed by their health-care providers 80 percent of the time. Their medication use was monitored over six months.
About half the patients in the study taking medications for the three chronic conditions hit the 80 percent adherent mark. The rates of adherence seen in this study are comparable to the rates seen in studies of patients with prescription insurance, Roberts says.
Percentage of PAP Patients Who Were 80 Percent Adherent
- 38 percent taking medication for high cholesterol (compared to 40 to 50 percent of patients with insurance)
- 52 percent taking medication for high blood pressure (compared to 36 to 56 percent of patients with insurance)
- 45 percent taking medication for diabetes (compared to 55 percent of patients with insurance)
In North Carolina, approximately 9 percent of adults have diabetes, 31 percent have high blood pressure, and approximately 34 percent have high cholesterol, according to the Centers for Disease Control and Prevention. The diseases selected for the study are some of the most costly conditions in the United States.
The study, published in the North Carolina Medical Journal, also found that PAP patients who took their medications as prescribed were more likely to be older, more likely to be white, and more likely to be taking multiple prescriptions.
Faculty from the UNC Eshelman School of Pharmacy, the UNC School of Medicine, and the UNC Gillings School of Global Public Health collaborated on the study, along with clinicians at UNC Health Care.
Studies show that improved medication adherence is associated with fewer hospitalizations and fewer emergency room visits, Roberts says.
Improving Health and Lowering Costs
Ginny Crisp, PharmD, is a pharmacist at UNC Hospitals, an assistant professor at the pharmacy school, and one of the study’s coauthors. She says the study will not only guide the operation of UNC’s assistance program, it will also be valuable to others.
“This study provides valuable evidence for administrators of similar charitable pharmacy assistance programs in other states serving large numbers of uninsured patients, primarily states that have opted out of expanding Medicaid eligibility under health reform,” Crisp says. “We have also identified clear opportunities to improve the pharmacy care here at UNC by increasing medication adherence of PAP participants and improving the care they receive.”
As a result of this study, UNC Health Care is implementing the Carolina Assessment of Medications Program, Crisp says. CAMP is a pharmacist-led clinic that provides personalized medication therapy management to patients with a focus on improving their medication adherence and health while at the same lowering costs for the health system.
UNC Health Care Pharmacy Assistance Program
From 2009 through 2011, the PAP at UNC Health Care served 7,180 patients from eighty-one counties in North Carolina. PAP users received an average of twenty-three prescriptions at an average cost of $754 per recipient per year. UNC Health Care spent an average of $2.93 million per year on the program. Inpatient care and emergency department care were used by approximately 30 percent of PAP participants.
The Study Authors
- Andrew Roberts, PharmD, is a postdoctoral fellow in health services research at the Cecil G. Sheps Center and a PhD candidate at the UNC Eshelman School of Pharmacy.
- Ginny Crisp, PharmD, is a clinical specialist at UNC Hospitals and an assistant professor in the Division of Practice Advancement and Clinical Education at the UNC Eshelman School of Pharmacy.
- Mary Roth McClurg, PharmD, MHS, is an associate professor in the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy.
- Denise Esserman, PhD, is an associate professor of biostatistics at the Yale University School of Public Health.
- Morris Weinberger, PhD, is a distinguished professor in the UNC Gillings School of Global Public Health and a senior research career scientist at the Durham VAMC Center for Health Services Research.
- Joel Farley, PhD, is an associate professor in the Division of Pharmaceutical Outcomes and Policy
The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Award Number 1UL1TR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.