Determinants of Self-Management Strategies to Reduce Out-of-Pocket Prescription Medication Expense in Homebound Older people

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Abstract
To determine the extent to which homebound older people adopt strategies to reduce out-of-pocket prescription medication cost and the factors associated with level of cost-related medication management. Cross-sectional study. Home-delivered meals programs in four North Carolina counties. Random sample of 222 home-delivered meal recipients aged 60 and older. The use of six different management strategies to reduce medication expenses was reported at the in-home assessment. Associations between level of cost-related medication management and sample characteristics, drug coverage, behaviors to cope with out-of-pocket medication expense, and payment difficulty were examined. Forty-five (20.3%) participants used one or more behaviors that restricted medication use; another 47 (21.2%) used one or more strategies to reduce out-of-pocket medication cost. Using medication restriction to reduce medication expense was more likely in older people who had difficulty paying for medications (odds ratio (OR)=8.2, 95% confidence interval (CI)=1.4-50.3), or used a strategy to cope with out-of-pocket expenses (choose food or medications (OR=5.1, 95% CI=1.7-15.7) or borrowed money or had another person pay for medications (OR=5.5, 95% CI=2.6-11.6)). Income, drug coverage, and medication use (prescribed and over-the-counter) increased the likelihood of having increased difficulty paying for medications. Clinicians should attempt to identify patients who are at risk for medication restriction and develop strategies for minimizing any unintended consequences of cost-related medication management behaviors. Provider-patient communication should include discussion of medication cost and appropriate medication management strategies.