Higher costs of long-term medications for children were associated with small reductions in adherence by parents, a cohort study shows. “Health care systems should consider child-level or even household-level spending in adherence interventions or prescription policy design,” the authors conclude.
Using an interrupted time-series analysis with a propensity score-matched control group from a large national US health insurer database (2010-2020), the study included children initiating long-term medication and their presumed parents. Based on the proportion of days covered in 30-day increments before and after the child’s first fill date, the investigators found: “Across 47,154 included pairs, the parents’ mean (SD) age was 42.8 (7.7) years. Compared with a low-cost medication, initiating a high-cost, long-term medication was associated with an immediate 1.9% (95% CI, −3.8% to −0.9%) reduction in parental adherence sustained over time (0.2%; 95% CI, −0.1% to 0.4%). Similar results were observed for short-term medications (0.6% immediate change; 95% CI, −1.3% to −0.01%). Previously adherent parents, parents using treatment for longer periods, and families who spent more out-of-pocket on medications were more sensitive to high costs, with immediate adherence reductions of 2.8% (95% CI, −4.9% to −0.6%), 2.7% (95% CI, −4.7% to −0.7%), and −3.8% (95% CI, −7.2% to −0.5%), respectively, after long-term medication initiation.”