Advertisement

Cost-related nonadherence with glaucoma medications in Ontario

Published:February 03, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.01.008

      Abstract

      Objective

      To determine the proportion of glaucoma patients in Ontario aged 25–64 who lack insurance coverage for glaucoma medications and to assess the frequency of cost-related nonadherence to glaucoma medications.

      Design

      Cross-sectional study.

      Participants

      Glaucoma patients on medication from 2 glaucoma clinics in Toronto, Ontario.

      Methods

      100 consecutive glaucoma patients aged 25–64 (not entitled to provincial drug benefit) and 100 consecutive glaucoma patients aged 65+ (entitled to provincial drug benefit), all on topical glaucoma therapy, completed a standardized questionnaire. Questions included insurance coverage for glaucoma medications, cost concerns when paying for glaucoma medications, cost-related nonadherence, and sociodemographics.

      Results

      25.8% of those aged 25–64 express concerns about the cost of their glaucoma medications compared to 7.1% of those aged 65+ (p < 0.001). Patients aged 25–64 were also significantly more likely to report at least one form of cost-related nonadherence (15.5% vs 2.0%, p = 0.001) and significantly more likely to report missing eye drops in a given week than patients aged 65+ (32.0% vs 16.7%, p = 0.01). 17% (95% confidence interval 11%–26%) of patients aged 25–64 self-reported having no insurance coverage for their glaucoma medications. Of those with coverage, the most common source of insurance was employer-sponsored (68.6%) with 44% requiring a copayment. The average copayment was $18 (range $2–$250) for those aged 25–64 compared with $5 in the 65+ group (range $0.62–$100).

      Conclusions

      17% of glaucoma patients aged 25–64 do not have coverage for their drops. One in four expressed concerns about the cost of their glaucoma medications, and 15.5% reported cost-related nonadherence.

      Objectif

      Déterminer la proportion de patients âgés de 25 à 64 ans qui présentent un glaucome et qui ne bénéficient d'aucune couverture d'assurance pour leurs médicaments antiglaucomateux en Ontario, et évaluer la fréquence du non-respect du traitement antiglaucomateux en raison du coût de ce dernier.

      Nature

      Étude transversale.

      Participants

      Patients sous médicaments antiglaucomateux issus de 2 cliniques de traitement du glaucome à Toronto, en Ontario.

      Méthodes

      Cent patients consécutifs qui présentaient un glaucome et qui étaient âgés entre 25 et 64 ans (qui ne sont donc pas admis au régime provincial d'assurance-médicaments) et 100 patients consécutifs qui présentaient un glaucome et qui étaient âgés de 65 ans et plus (qui sont donc admis au régime provincial d'assurance-médicaments) ont répondu à un questionnaire standardisé. Les 200 sujets recevaient des collyres antiglaucomateux. Les questions portaient sur la couverture d'assurance pour les médicaments antiglaucomateux, les inquiétudes quant au paiement de tels médicaments, le non-respect du traitement en raison du coût et les paramètres sociodémographiques.

      Résultats

      Quelque 25,8 % des sujets âgés entre 25 et 64 ans ont signalé avoir des inquiétudes quant au coût de leurs médicaments antiglaucomateux, comparativement à 7,1 % des sujets âgés de 65 ans et plus (p < 0,001). De même, les patients âgés entre 25 et 64 ans étaient significativement plus susceptibles de signaler au moins une forme de non-respect du traitement en raison de son coût (15,5 % vs 2,0 %; p = 0,001), et significativement plus susceptibles de signaler avoir manqué des doses de leurs collyres pendant une semaine donnée, comparativement aux patients âgés de 65 ans et plus (32,0 % vs 16,7 %; p = 0,01). Par ailleurs, 17 % (intervalle de confiance à 95 % : 11 %–26 %) des patients âgés entre 25 et 64 ans ont signalé n'avoir aucune assurance pour leurs médicaments antiglaucomateux. Pour ce qui est des patients qui bénéficiaient d'une couverture d'assurance, la source la plus fréquente de l'assurance était celle de l'employeur (68,6 %), qui exigeait une quote-part dans 44 % des cas. La quote-part moyenne s’élevait à 18 $ (fourchette : 2 $ à 250 $) pour les patients âgés entre 25 et 64 ans et de 5 $ (fourchette : 0,62 $ à 100 $) pour les âgés de 65 ans et plus.

      Conclusions

      Ainsi, 17 % des patients qui présentent un glaucome et qui sont âgés entre 25 et 64 ans ne bénéficient d'aucune couverture d'assurance pour leurs collyres. Un patient sur 4 a exprimé une inquiétude quant au coût de ses médicaments antiglaucomateux, et 15,5 % des sujets ont signalé ne pas toujours observer leur traitement médicamenteux en raison de son coût.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Briesacher BA
        • Gurwitz JH
        • Soumerai SB.
        Patients at-risk for cost-related medication nonadherence: a review of the literature.
        JGIM. 2007; 22: 864-871
        • Hennessy D
        • Sanmartin C
        • Ronksley P
        • et al.
        Out-of-pocket spending on drugs and pharmaceutical products and cost-related prescription non-adherence among Canadians with chronic disease.
        Health Rep. 2016; 27: 3-8
        • Morgan SG
        • Lee A.
        Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries.
        BMJ Open. 2017; 7e014287
        • Piette JD
        • Heisler M
        • Wagner TH.
        Cost-related medication under-use among chronically ill adults: the treatments people forgo, how often, and who is at risk.
        Am J Public Health. 2004; 94: 1782-1787
        • Gupta S
        • McColl MA
        • Guilcher SJ
        • Smith K.
        Cost-related nonadherence to prescription medications in Canada: a scoping review.
        Patient Prefer Adherence. 2018; 12: 1699-1715
        • Holbrook AM
        • Wang M
        • Lee M
        • et al.
        Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact.
        Syst Rev. 2021; 10: 11https://doi.org/10.1186/s13643-020-01558-5
        • Quigley HA
        • Broman AT.
        The number of people with glaucoma worldwide in 2010 and 2020.
        Br J Ophthalmol. 2006; 90: 262-267
        • Feehan M
        • Munger MA
        • Cooper DK
        • et al.
        Adherence to glaucoma medications over 12 months in two US community pharmacy chains.
        J Clin Med. 2016; 5: 79
        • Sheer R
        • Bunniran S
        • Uribe C
        • Fiscella RG
        • Patel VD
        • Chandwani HS.
        Predictors of nonadherence to topical intraocular pressure reduction medications among Medicare members: a claims-based retrospective cohort study.
        J Manag Care Spec Pharm. 2016; 22: 808-817
        • Sleath B
        • Blalock S
        • Covert D
        • et al.
        The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity.
        Ophthalmology. 2011; 118: 2398-2402
        • Rossi GCM
        • Pasinetti GM
        • Scudeller L
        • Radaelli R
        • Bianchi PE.
        Do adherence rates and glaucomatous visual field progression correlate?.
        Eur J Ophthalmol. 2011; 21: 410-414
        • Newman-Casey PA
        • Niziol LM
        • Gillespie BW
        • Janz NK
        • Lichter PR
        • Musch DC.
        The association between medication adherence and visual field progression in the collaborative initial glaucoma treatment study.
        Ophthalmology. 2020; 127: 447-483
        • Leung VC
        • Jin YP
        • Hatch W
        • et al.
        The relationship between sociodemographic factors and persistence with topical glaucoma medications.
        J Glaucoma. 2015; 24: 69-76
        • Law M
        • Cheng L
        • Dhalla I
        • Heard D
        • Morgan S.
        The effect of cost on adherence to prescription medications in Canada.
        CMAJ. 2012; 184: 297-302
      1. Canadian Community Health Survey (CCHS) Rapid Response January-June 2016 - Prescriptions - Cost-related Non-adherence.
        Statistics Canada, Ottawa (ON)2020 (Accessed 15 June 2020)
        • Hodapp E
        • Parrish II, RK
        • Anderson DR
        Clinical Decisions in Glaucoma.
        The C.V. Mosby Company, St Louis, MO1993
        • Ngo G
        • Trope GE
        • Buys YM
        • Jin YP.
        Significant disparities in eyeglass insurance coverage in Canada.
        Can J Ophthalmol. 2018; 53: 260-265
      2. Get coverage for prescription drugs. Government of Ontario. 2020. https://www.ontario.ca/page/get-coverage-prescription-drugs#section-1. Accessed 22 July 2020.

        • Kholdebarin R
        • Campbell RJ
        • Jin YP
        • Buys YM.
        Multicenter study of compliance and drop administration in glaucoma.
        Can J Ophthalmol. 2008; 43: 454-461
        • Blumberg DM
        • Prager AJ
        • Liebmann JM
        • Cioffi GA
        • De Moraes CG.
        Cost-related medication nonadherence and cost-saving behaviors among patients with glaucoma before and after the implementation of medicare part D.
        JAMA Ophthalmol. 2015; 133: 985-996