Blog & News
A State-level Measure of Drug Affordability on State Health Compare: Made Changes to Medical Drugs Because of Cost
February 25, 2019: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
SHADAC’s State Health Compare measure “Made Changes to Medical Drugs” is produced using the National Health Interview Survey (NHIS), for which State Health Compare is the only source of state-level estimates, providing a unique way to see how the cost of prescriptions and other medical drugs affects Americans’ ability to afford these medications across and within states. |
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.
Other State Health Compare estimates that use data from the NHIS
Made Changes to Medical Drugs is one of eight State Health Compare measures that SHADAC produces using data from the NHIS listed below. State Health Compare is the only source for state-level estimates of these measures.
- Made Changes to Medical Drugs
- Trouble Paying Medical Bills
- No Trouble Finding Doctor
- Told that Provider Accepts Insurance
- Had Usual Source of Medical Care
- Had General Doctor or Provider Visit
- Had Emergency Department Visit
- Spent the Night in a Hospital
[1] Roehing, C. May 2018. Projections of the Prescription Drug Share of National Health Expenditures Including Non-Retail. Altarum Report. Available at: https://altarum.org/sites/default/files/uploaded-publication-files/Projections_of_the_Prescription_Drug_Share_of_National_Health_Expenditures_June_2018.pdf
Blog & News
SHADAC Releases 50-State Analysis of the Evolving Opioid Crisis (Infographics)
February 11, 2019:Much of the attention paid to the national opioid crisis in recent years has focused on the national toll of the crisis, such as the more than 44,000 opioid overdose deaths reported nationally in 2017.[1] However, the dynamics of the crisis vary widely across states, both in the prevalence of opioid overdose deaths and the types of opioids associated with those deaths.
To make state-specific information on opioid overdose deaths more easily accessible, SHADAC has used estimates from our State Health Compare online data tool to create a set of two-page infographics for all 50 states and the District of Columbia that include new data on drug overdose deaths for 2017.
Additionally, because of growing concern and evidence that the opioid crisis may be expanding to other non-opioid illicit drugs, we also have included data on drug overdose deaths from two types of drugs that are commonly involved in opioid overdoses: cocaine and psychostimulants (such as methamphetamine). [2],[3]
HIGHLIGHTS
Background: U.S. trends in drug overdose deaths
At the national level, data on opioid overdose deaths show multiple, evolving phases of the overdose epidemic. From 2000 to approximately 2011, the growth in opioid overdose deaths was driven primarily by natural and semi-synthetic opioids (i.e., prescription opioid painkillers); but that death rate has since largely plateaued. Beginning around 2011, deaths from heroin began to increase more rapidly and were responsible for the highest overdose death rates in 2015. Since around 2013, however, deaths from synthetic opioids, such as fentanyl, have grown precipitously, and in 2017 the overdose death rate from synthetic opioids was nearly double the rate for all other drug types.
Around the same time that death rates from heroin and synthetic opioids began to increase, deaths from cocaine and psychostimulants also began to increase. Evidence suggests that this relationship is driven, at least in part, by an increase in deaths that involve multiple drugs. Since 2011, when deaths from heroin began to rise, death rates from cocaine have nearly tripled, from 1.5 per 100,000 people to 4.3 per 100,000 people in 2017; and death rates from psychostimulants have more than quadrupled, from 0.7 per 100,000 people to 3.2 per 100,000 people in 2017.
State variation in overdose deaths
Opioid Overdose Deaths
Although most states have experienced measurable increases in opioid overdose deaths since 2000, the scale of the crisis has varied widely across states. For example, West Virginia’s rate of deaths from synthetic opioids in 2017 was more than 30 times the rate of Nebraska and Texas (37.4 deaths versus 1.3 deaths per 100,000 people).
The types of opioids most commonly associated with overdoses also vary across states. For instance, Utah had the second-highest rate of deaths from natural and semi-synthetic opioids in 2017, at 10.0 deaths per 100,000 people; however, contrary to the U.S. trend, the state has experienced relatively little growth in deaths from synthetic opioids, and the state’s 2017 death rate from synthetic opioids (3.1 per 100,000 people), fell well below the U.S. rate of 9.0 per 100,000 people.
Overdose Deaths from Cocaine and Psychostimulants
The scale of overdose deaths from non-opioid illicit drugs also varies widely across states. For example, the 2017 overdose death rate from cocaine in the District of Columbia (17.6 deaths per 100,000 people) was 22 times the rate of Arkansas and Kansas (0.8 deaths per 100,000 people). Similarly, the 2017 overdose death rate from psychostimulants in West Virginia (13.6 deaths per 100,000 people) was more than 15 times the rate of 0.9 deaths per 100,000 people in New Jersey.
Regional Patterns in Drug Overdose Death Rates
Despite the evidence of state variation in drug overdose death rates, further analysis does illustrate some broader patterns:
Heroin and synthetic opioids
Death rates from heroin and synthetic opioids are generally higher east of the Mississippi River, particularly among states in the Northeast, the Appalachian region, and the industrial Midwest.
Natural and semi-synthetic opioids
Higher death rates from natural and semi-synthetic opioids are more geographically dispersed than those from heroin and synthetic opioids. While some states in the eastern U.S. have particularly high rates of deaths from natural and semi-synthetic opioids (e.g., Kentucky, Ohio, and West Virginia), there are other states in the western U.S. that also have similarly high death rates from these drugs (e.g., Utah, New Mexico, and Nevada).
Cocaine
An examination of cocaine death rates reveals a pattern similar to that of death rates from heroin and synthetic opioids, with states east of the Mississippi River exhibiting higher rates of cocaine overdose deaths.
Psychostimulants
Death rate patterns from psychostimulants appear to be almost the opposite of those for heroin and synthetic opioids, with relatively low death rates in the Northeast and particularly high rates of deaths in the western U.S. and the Southeast. Only a group of three state—Kentucky, Ohio, and West Virginia—shows strong overlaps between psychostimulant and heroin and synthetic opioid deaths.
Access the state-level infographics on drug overdose deaths.
Explore the data on drug overdose deaths on State Health Compare.
Further Reading and Resources
New Data on Drug Overdose Death Highlight the Need for State-Level Analysis
SHADAC Blog, December 2018
Exploring the New State-Level Opioid Data on SHADAC’s State Health Compare
SHADAC Webinar (Recording and Presentation Materials), September 2018
The Changing Opioid Epidemic: State Trends, 2000-2016
SHADAC Blog, August 2018
The Changing Opioid Epidemic: National Trends, 2000-2016
SHADAC Blog, July 2018
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths, 2000-2016
SHADAC Issue Briefs, June 2018
[1] This number includes deaths from natural and semi-synthetic opioids (e.g., prescription opioid painkillers), heroin and synthetic opioids (e.g., fentanyl), but it excludes some opioids with relatively fewer deaths, such as methadone.
[2] Although reports of illicit drugs being tainted with synthetic opioids are relatively common, it is unclear whether deaths involving multiple drugs are typically the result of drugs being intentionally mixed by or unintentionally contaminated through traffickers’ sloppiness, or because individual drug users are concurrently abusing multiple different drugs of their own volition.
[3] U.S. Centers for Disease Control and Prevention. (2018, December 12). Drugs Most Frequently Involved in Drug Overdse Deaths: United States, 2011-2016. National Vital Stastics Report, 67(9), 1-14. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf
Blog & News
State Health Compare Updated to Include 2017 Opioid-Related Overdose Data and New Data on Overdose Deaths from Other Drugs
January 18, 2019:SHADAC has recently updated our State Health Compare estimates on opioid-related drug overdose deaths to include data from 2017. Data on this measure, which examines natural and semi-synthetic opioids, synthetic opioids, and heroin, are now available for years 1999 to 2017.
We have also added new data on drug overdose deaths associated with cocaine and psychostimulants (e.g., methamphetamine), which have increased in recent years — an increase that evidence suggests may be related to the growing opioid crisis.
Users are able to view estimates for all available data years and for all five drug types at both the national and state level.
Access the updated and new estimates.
Highlights: National Trends, 1999-2017
At the national level, the opioid overdose epidemic has borne out and evolved over multiple phases since 1999. From 1999 through 2014, natural and semi-synthetic opioids (i.e., prescription painkillers) had the highest death rate among opioids. In 2015, heroin overtook prescription painkillers for a brief period with the highest death rate among opioids. But by 2016, deaths from synthetic opioids, such as fentanyl, became the foremost cause of opioid-related overdose death rates nationwide, a trend that continued in 2017.
Among overdose deaths associated with non-opioids, cocaine-related deaths have consistently exceeded those of psychostimulants at the national level since 1999, although the two overdose categories began increasing in tandem around 2013 and have continued upward since then. However, death rates from cocaine and psychostimulants have remained below opioid-related death rates since 2013.
Since 1999:
- Death rates from natural and semi-synthetic opioids (i.e., prescription painkillers) have more than quadrupled, from 1.0 per 100,000 people to 4.4 per 100,000 people in 2017.
- Death rates from synthetic opioids have grown thirty-fold, from 0.3 per 100,000 people to 9.0 per 100,000 people in 2017.
- Death rates from heroin have grown seven-fold from 0.7 per 100,000 people to 4.9 per 100,000 people in 2017.
- Death rates from cocaine have more than tripled, from 1.4 per 100,000 people to 4.3 per 100,000 people in 2017.
- Death rates from psychostimulants have grown by a factor of sixteen, from 0.2 per 100,000 people to 3.2 per 100,000 people in 2017.
Highlights: Regional and State Estimates, 2017
At the state level, both the levels of death rates and the types of drug which were the dominant causes of death varied widely in 2017. For example:
- West Virginia’s rate of deaths from synthetic opioids (e.g., fentanyl) in 2017, at 37.4 per 100,000 people, was the highest in the country and more than 30 times the rates of states such as Nebraska and Texas (1.2 per 100,000 people).
- Utah had the second-highest rates of deaths from natural and semi-synthetic opioids in 2017, at 10.0 deaths per 100,000 people; however, compared to the U.S. trend, the state has experienced relatively little growth in deaths from synthetic opioids.
- Death rates from cocaine, heroin, and synthetic opioids in 2017 were generally higher east of the Mississippi River, particularly among states in the Northeast, Appalachian region, and the industrial Midwest.
- The western U.S. and the Southeast, along with the Appalachian region, had higher rates of overdose deaths in 2017 for psychostimulants compared with the Northeast.
State variations in overdose death rates have prompted a recent shift in focus for both data analysis and public health intervention to the state level.
Explore these updated and additional estimates on State Health Compare.
Further Reading and Resources
New Data on Drug Overdose Death Highlight the Need for State-Level Analysis
The Changing Opioid Epidemic: State Trends, 2000-2016
The Changing Opioid Epidemic: National Trends, 2000-2016
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths, 2000-2016 (Briefs)
Blog & News
MACStats from MACPAC: 2018 Medicaid and CHIP Data Book Now Available
February 1, 2019:The Medicaid and CHIP Payment and Access Commission (MACPAC) recently released the 2018 version of its Medicaid and CHIP Data Book. This data book is a collection of federal and state statistics regarding the Medicaid and CHIP programs that are compiled by MACPAC from multiple data sources on key topic areas including Medicaid and CHIP eligibility, enrollment, and expenditures, as well as beneficiary health, service use, and access to care. An excellent resource, the data book draws on a wide variety of data sources including Medicaid administrative data (e.g., CMS-64 data, MSIS data, Medicaid Managed Care enrollment reports, etc.) as well as federal survey data in order to compile policy relevant, but difficult to access, information about the Medicaid and CHIP programs into one comprehensive tool.
SHADAC is excited to be among the contractors that contributed to this product, providing MACPAC with estimates from the National Health Insurance Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS) that highlight individual enrollment, primary source of insurance coverage, and service use and access to care with breakdowns available by age, demographics, and health characteristics. SHADAC produced these estimates using data for years 2016 and 2017, which are the latest available respectively for each survey.
For additional information on data methods and sources used in the data book, see MACPAC’s Technical Guide to MACStats, which provides supplementary information to help readers interpret the exhibits in the MACStats tables and figures as well as to understand the data sources and methods used.
Blog & News
Register Now: February 6th Webinar - Exploring Disparities Using SHADAC's State Health Compare
January 28, 2019:Exploring Disparities Using New and Updated Measures on SHADAC’s State Health Compare: State-Level Highlights for Unaffordable Rents, Unhealthy Days, and More
Date: February 6, 2019
Time: 1:00 p.m. – 2:00 p.m. Central
Register now.
Join us on Wednesday, February 6th at 1:00 PM Central for a webinar introducing two new measures of health outcomes and social determinants of health on SHADAC’s State Health Compare—Unhealthy Days and Unaffordable Rents. This presentation, hosted by SHADAC researchers Brett Fried and Robert Hest, will examine these new measures and highlight how the estimates can be used to explore disparities between states and among sub-populations.
The webinar will also provide a virtual tour of some of the more than 40 state-level measures currently available on State Health Compare, highlighting recently updated data in particular. Mr. Fried and Mr. Hest will demonstrate how users can employ State Health Compare to easily create compelling maps, charts, and graphs, as well as download the raw estimates to perform deeper analyses and statistical testing.
SHADAC researchers will answer questions from attendees after the presentation.
Adult Unhealthy Days: A New Measure on State Health Compare
SHADAC Blog
Housing Affordability Matters: Measuring and Addressing the Burden of Unaffordable Rents
SHADAC Blog
Examining Unaffordable Rents as a Social Determinant of Health
SHADAC Publication - Infographics
Significance Testing Using State Health Compare
SHADAC Brief