Despite Programs, Medication Unaffordable for Many Stroke Survivors

Allison Gandey

February 23, 2011

February 23, 2011 (Los Angeles, California) — Results of a national survey show that 11% of stroke patients report they aren't taking their medications because they can't afford them. This is leaving high-risk patients vulnerable to future strokes or other cardiovascular events.

US stroke survivors by age and study period

"Despite federal and local programs, medication is still unaffordable for many stroke survivors," lead investigator Deborah Levine, MD, from the University of Michigan at Ann Arbor told reporters attending a news conference here at the American Stroke Association International Stroke Conference 2011.

Dr. Levine's work was among the highest-scoring abstracts at the meeting.

Chelsea Kidwell, MD, medical director of the Georgetown Stroke Center in Washington, DC, called the study "very interesting and important." She pointed out that secondary prevention, which includes medication adherence, "provides an enormous opportunity to decrease overall morbidity and mortality from stroke."

Dr. Levine called on clinicians to screen for cost-related medication underuse and consider less expensive options for these patients.

Dr. Deborah Levine

"Federal programs to reduce cost-related nonadherence to medication may not be working as intended," Dr. Levine said. "There is no evidence that Medicare Part D solved the problem."

The program was first implemented to reduce cost-related medication nonadherence in older or disabled adults. Under Medicare Part D, people could purchase insurance coverage for prescription drugs.

The average stroke survivor takes 11 different medications.

Dr. Levine's team evaluated this program using the National Health Interview Survey from 2006 to 2009. They compared these results to their 2007 study published in the Archives of Neurology.

The researchers studied 2656 stroke survivors. In all, 42% of Medicare beneficiaries reported having Medicare Part D; however, cost-related nonadherence to medication was twice as high among those with the prescription drug benefit as in those without.

Medication Nonadherence Due to Cost by Medicare Part D Status

Measure With Medicare Part D Without Medicare Part D P Value
Medication nonadherence (%) 12 6 < .001

"Interventions that provide affordable health insurance and that reduce or eliminate costs for medications to prevent recurrent stroke are needed for vulnerable stroke survivors who cannot afford their medication," Dr. Levine said.

Surgeon General C. Everett Koop famously stated, "Drugs don't work in patients who don't take them."

Asked by Medscape Medical News to comment on these findings, Robert Adams, MD, director of the Medical University of South Carolina Stroke Center in Charleston, said he's not surprised stroke patients are having trouble affording their medications.

"It seems counterintuitive that Medicare Part D enrollees would be having even more difficulty, but it goes to show that we have a long way to go in secondary stroke prevention."

Dr. Adams pointed out that patients can be receiving the best guideline-based care available, but when they are discharged from hospital, "they can fall out of the compliance box for all kinds of reasons. We need to hone in on when and why people stop taking their medications and work to correct the problems."

The researchers have disclosed no relevant financial relationships.

American Stroke Association International Stroke Conference 2011. Abstract #212. Presented February 10, 2011.

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