Determinants of self-management strategies to reduce out-of-pocket prescription medication expense in homebound older people

OBJECTIVES: To determine the extent to which homebound older people adopt strategies to reduce out-of-pocket prescription medication cost and the factors associated with level of cost-related medication management. DESIGN: Cross-sectional study. SETTING: Home-delivered meals programs in four North Carolina counties. PARTICIPANTS: Random sample of 222 home-delivered meal recipients aged 60 and older. MEASUREMENTS: The use of six different management strategies to reduce medication expenses was reported at the in-home assessment. Associations between level of cost-related medication management and sample characteristics, drug coverage, behaviors to cope with out-of-pocket medication expense, and payment difficulty were examined. RESULTS: Forty-five (20.3%) participants used one or more behaviors that restricted medication use; another 47 (21.2%) used one or more strategies to reduce out-of-pocket medication cost. Using medication restriction to reduce medication expense was more likely in older people who had difficulty paying for medications (odds ratio (OR) = 8.2, 95% confidence interval (CI) = 1.4-50.3), or used a strategy to cope with out-of-pocket expenses (choose food or medications (OR = 5.1, 95% CI = 1.7-15.7) or borrowed money or had another person pay for medications (OR = 5.5, 95% CI = 2.6-11.6)). Income, drug coverage, and medication use (prescribed and over-the-counter) increased the likelihood of having increased difficulty paying for medications. CONCLUSION: Clinicians should attempt to identify patients who are at risk for medication restriction and develop strategies for minimizing any unintended consequences of cost-related medication management behaviors. Provider-patient communication should include discussion of medication cost and appropriate medication management strategies.