Acne medication cost a major barrier to adherence
Cost of treatment is a major driver of patients’ primary nonadherence to acne medication, according to a recent study. Physicians who openly discuss medications costs and provide a plan of action in case patients are unable to fill prescriptions may improve treatment adherence.
The researchers conducted 26 structured interviews with patients (73 percent female) who were nonadherent to acne medications. The transcripts were subjected to a thematic analysis to identify themes and ideas regarding nonadherence, particularly about modifiable physician-level factors.
Five main themes emerged, of which medication costs appeared to be the largest barrier to adherence. Majority of the participants (65 percent; n=17) reported intending to fill the prescriptions but were unable to because of affordability issues. The most common concerns in this theme were high out-of-pocket costs (42 percent) and lack of insurance coverage (38 percent). [JAMA Dermatol 2018;doi:10.1001/jamadermatol.2017.6144]
Another main barrier was a poor understanding of the prior authorization process. Five out of the 26 respondents (19 percent) received conflicting information about needing approval from health insurance provider before a clinician may prescribe certain medications. Other problems in this theme included the fragmented interactions between physicians and pharmacists.
Some participants also reported having reservations about the plan of treatment (38 percent; n=10). Concerns in this theme included the belief that the acne was not serious enough to warrant medication (12 percent), unwillingness to initiate a medication considered to be strong (8 percent) and concerns about potential adverse effects (15 percent).
Physician-patient communication may also play a part. While participants generally regarded physician visits as beneficial and informative, and while they reported extensive conversations about treatment efficacy and safety, no such discussions about medication cost concerns were initiated.
“Although participants expressed general familiarity and concern with issues related to medication costs, they did not share these concerns with physicians and did not expect physicians to know medication cost or insurance coverage,” according to researchers.
The solutions to cost concerns commonly offered by physicians included asking patients to shop around, asking patients to call back and suggesting alternatives to the first-line medication, all of which were reported by 7 percent (n=2) of the participants. One patient reported being offered coupons to subsidize medication costs.
Participants reported generally appreciating frank discussions about medication costs (19 percent; n=5) and being offered back-up and alternative plans of action (23 percent; n=6). Suggestions to shop around or to call the office back were not well-received.
The present findings show that the steep cost of acne medication, along with insufficient insurance coverage, is the main barrier to treatment adherence. Moreover, “[d]espite anticipating insufficient insurance coverage, patients were reluctant to address concerns with physicians and generally did not expect physicians to be knowledgeable in this area,” noted researchers.
“While this experience did not appear to negatively affect satisfaction with the physicians, physicians who discuss medication costs and provide a concrete alternative plan may be able to improve primary adherence among their patients,” they added.