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In Research in social & administrative pharmacy : RSAP

BACKGROUND : Prescription affordability is a key component of healthcare accessibility and a determinant of health outcomes. Prior studies indicate that up to 1 in 4 Americans report difficulty affording prescriptions.

OBJECTIVE(S) : This study aims to identify factors associated with cost-based prescription refusal.

METHODS : We identified 17,869 study participants from the 2017 National Health Interview Survey who had been prescribed at least one medication in the past 12 months. The outcome was defined as inability to afford at least one prescription medication. Covariates included demographic data, medical history, and social attitudes. Logistic regression models were constructed to identify predictors of cost-based prescription refusal.

RESULTS : Among 8223 study participants, 8.1% reported the inability to afford at least one prescription medication in the past 12 months. Twenty-seven covariates were correlated with prescription unaffordability, and 8 were selected by the LASSO: Income (Odds ratio (OR) 0.55), Concerned About Bills (OR 2.0), Emergency Department Visits past 12 months (OR 1.33), Dissatisfaction with Medical Care (OR 1.3), Seeking Insurance Through the Health Insurance Marketplace (OR 1.26), Feeling Sad Most of the Time (OR 1.24), History of Asthma (OR 1.26) and History of Diabetes (OR 1.24).

CONCLUSIONS : Prescription unaffordability remains a significant public health problem and is more common among low-income individuals and patients with, chronic medical conditions.

Donnenberg N S, Hernandez I, Normolle D P


Drug affordability, LASSO, Machine learning, Medication nonadherence, National health interview survey, Pharmacoeconomics