Patients at-risk for cost-related medication nonadherence: a review of the literature

UMMS Affiliation

Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute

Publication Date


Document Type



Chronic Disease; Cost Sharing; *Cost of Illness; Depression; Humans; Pharmaceutical Preparations; Polypharmacy; *Prescription Fees; Risk; Risk Assessment; Socioeconomic Factors; *Treatment Refusal


Health Services Research | Life Sciences | Medicine and Health Sciences | Primary Care


OBJECTIVE: Up to 32% of older patients take less medication than prescribed to avoid costs, yet a comprehensive assessment of risk factors for cost-related nonadherence (CRN) is . This review examined the empirical literature to identify patient-, medication-, and provider-level factors that influence the relationship between medication adherence and medication costs.

DESIGN: We conducted searches of four databases (MEDLINE, CINAHL, Sciences Citations Index Expanded, and EconLit) from 2001 to 2006 for English-language original studies. Articles were selected if the study included an explicit measure of CRN and reported results on covarying characteristics.

MAIN RESULTS: We found 19 studies with empirical support for concluding that certain patients may be susceptible to CRN: research has established consistent links between medication nonadherence due to costs and financial burden, but also to symptoms of depression and heavy disease burden. Only a handful of studies with limited statistical methods provided evidence on whether patients understand the health risks of CRN or to what extent clinicians influence patients to keep taking medications when faced with cost pressures. No relationship emerged between CRN and polypharmacy.

CONCLUSION: Efforts to reduce cost-related medication nonadherence would benefit from greater study of factors besides the presence of prescription drug coverage. Older patients with chronic diseases and mood disorders are at-risk for CRN even if enrolled in Medicare's new drug benefit.

DOI of Published Version



J Gen Intern Med. 2007 Jun;22(6):864-71. Epub 2007 Apr 5. Link to article on publisher's site

Journal/Book/Conference Title

Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine

Related Resources

Link to Article in PubMed

PubMed ID