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A State-level Measure of Drug Affordability on State Health Compare: Made Changes to Medical Drugs Because of Cost

Americans spend more on prescription medications per capita than residents of any other nation due to higher U.S. drug prices. In 2016, prescription drugs accounted for an estimated 14.1 percent of total national health care costs, or $471 billion. [1],[2] The high prices of prescription drugs have captured current national attention, with both the Trump Administration and congressional lawmakers proposing a number of solutions to the issue.

State Health Compare: Americans Are Making Changes to Their Medical Drugs Due to Cost

According to estimates from SHADAC’s State Health Compare, many Americans are making changes to their medical drugs in response to rising drug prices. In 2016, 28.0% of non-elderly adults (ages 19-64) said that due to cost they asked their doctor for cheaper medications, delayed refills, took less medication than prescribed, skipped doses, used alternative therapies, and/or bought medications out of the country.

The percentage of the U.S. population that made changes to drugs due to cost has been relatively stable over time at the national level, but there are substantial differences by state and significant disparities exist between age groups and types of insurance coverage. 

MADE CHANGES TO MEDICAL DRUGS: HIGHLIGHTED ESTIMATES

There are significant differences by state in cost-related drug changes

As shown in the figure below, there is substantial state variation in the percent of non-elderly adults who report making changes to medical drugs due to cost, ranging from 16.4% in Massachusetts to 41.1% in Mississippi, a gap of 24.7 percentage points.

Percent of Non-elderly Adults Who Made Changes to Medical Drugs Because of Cost by State, 2016

Elderly adults were less likely to make changes to drugs due to cost                            

At the national level, elderly adults (age 65 and older) were less likely to report having made changes to their medical drugs due to cost relative to non-elderly adults (ages 18 to 64) at 22.7% vs. 28.0%, respectively. This difference may be related to the near-universal coverage of elderly adults through the Medicare program (though Medicare has limited drug coverage) compared to the relatively high rates of uninsurance among the non-elderly adult population. The discrepancy could also be due to differences in the resources that individuals in these two age groups have available to pay for drugs.

At the state level, there are large, statistically significant differences between elderly and non-elderly adults in the percentage of each group that made changes to medical drugs due to cost, as shown in the figure below. These differences range from a high of 13.1 percentage points in New Mexico (27.8% for those ages 19-64 vs. 14.7% for those ages 65+) to a low of 1.2 percentage points in Louisiana (31.7% for those ages 19­-64 vs. 30.5% for those ages 65+) and Washington (30.9% for those ages 19-64 vs. 29.7% for those ages 65+).

Percent Who Made Changes to Medical Drugs Because of Cost by State and Age, 2016

Those with health insurance are less likely to have made changes to drugs due to cost

Individuals with health insurance coverage were less likely to have made changes to medical drugs due to cost compared with uninsured individuals in 2016. At the national level, the share of the population that reported making changes to medical drugs due to cost was 23.6% for non-elderly adults with private coverage, 28.7% for non-elderly adults with public coverage, and 43.5% for non-elderly adults with no coverage. This represents a gap of 19.9 percentage points between private coverage and no coverage.^[3]

Percent Who Made Changes to Medical Drugs Because of Cost by Coverage Type, 2016

Notes and Definitions

Made Changes to Medical Drugs is defined as the rate of individuals who made changes to medical drugs because of cost during the past twelve months by age for the civilian non-institutionalized population. This includes asking the doctor for cheaper medications, delaying refills, taking less medication than prescribed, skipping dosages, using alternative therapies, and/or buying medications out of the country.

The source of the estimates is SHADAC analysis of NHIS data, National Center for Health Statistics (NCHS). The NHIS sample is drawn from the Integrated Health Interview Survey (IHIS, MN Population Center and SHADAC). Data were analyzed at the University of Minnesota's Census Research Data Center because state identifiers were needed to produce results and these variables were restricted.

Estimates were created using the NHIS survey weights, which are calibrated to the total U.S. Civilian non-institutionalized population for estimates broken down by age, and to the civilian non-institutionalized population age 18 to 64 for estimates broken down by coverage type.

Though SHADAC goes to great effort to produce as many state-level estimates as possible for our measures, due to sample size restrictions many state estimates of this measure are suppressed when broken down by coverage type. Namely, estimates are suppressed if the number of sample cases was too small or the estimate had a relative standard error greater than 30 percent. Among those with private coverage, 46 state estimates are available; among those with public coverage, 7 state estimates are available; and among the uninsured, 2 state estimates are available.