Cost-related medication underuse: Prevalence among hospitalized managed care patients

Niteesh K. Choudhry, Uzaib Y. Saya, William H. Shrank, Jeffrey O. Greenberg, Caroline Melia, Amy Bilodeau, Emily K. Kadehjian, Mary Lou Dolan, Jessica C. Dudley, Allen Kachalia

Research output: Contribution to journalArticlepeer-review


Background: The affordability of prescription medications continues to be a major public health issue in the United States. Estimates of cost-related medication underuse come largely from surveys of ambulatory patients. Hospitalized patients may be vulnerable to cost-related underuse and its consequences, but have been subject to little investigation. Objective: To determine impact of medication costs in a cohort of hospitalized managed care beneficiaries. Methods: We surveyed consecutive patients admitted to medical services at an academic medical center. Questions about cost-related underuse were based on validated measures; predictors were assessed with multivariable models. Participants were asked about strategies to improve medication affordability, and were contacted after discharge to determine if they had filled newly prescribed medications. Results: One-hundred thirty (41%) of 316 potentially eligible patients participated; 93 (75%) of these completed postdischarge surveys. Thirty patients (23%) reported cost-related underuse in the year prior to admission. In adjusted analyses, patients of black race were 3.39 times (95% confidence interval [CI], 1.05 to 11.02) more likely to report cost-related underuse than non-Hispanic white patients. Virtually all respondents (n = 123; 95%) endorsed at least 1 strategy to make medications more affordable. Few (16%) patients, prescribed medications at discharge, knew how much they would pay at the pharmacy. Almost none had spoken to their inpatient (4%) or outpatient (2%) providers about the cost of newly prescribed drugs. Conclusions: Cost-related underuse is common among hospitalized patients. Individuals of black race appear to be particularly at risk. Strategies should be developed to address this issue around the time of hospital discharge.

Original languageEnglish (US)
Pages (from-to)104-109
Number of pages6
JournalJournal of hospital medicine
Issue number2
StatePublished - Feb 1 2012
Externally publishedYes

ASJC Scopus subject areas

  • Leadership and Management
  • Internal Medicine
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

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