Strategies Used by Adults With Diagnosed Diabetes to Reduce Their Prescription Drug Costs, 2017–2018

August 21, 2019

Questions for Robin Cohen, Ph.D. and Lead Author of ”Strategies Used by Adults with Diagnosed Diabetes to Reduce Their Prescription Drug Costs, 2017-2018.”

Q: What do you think is the most significant finding in your report?

RC: Among adults with diagnosed diabetes, more than 13 percent did not take their medication as prescribed to save money and almost 1 in 4 asked their doctor for a lower cost medication.


Q: Do you have other data that would put these diabetes findings in context with other diseases?

RC: We have not looked at strategies adults use to reduce their prescription for other diseases. However, two previously published reports examined strategies used by adults aged 18-64 (https://www.cdc.gov/nchs/products/databriefs/db333.htm) and by adults aged 65 and over (https://www.cdc.gov/nchs/products/databriefs/db335.htm) to reduce their prescription drug costs in 2016-2017.


Q: Do you have any data on this topic for earlier years?

RC: We do not have reports addressing strategies used by adults with diagnosed diabetes for earlier years. However, two previous reports examined strategies used by adults to reduce their prescription drug costs in 2011 and 2013.


Q: Which age group or demographic group seems to be having the biggest problem with the cost of diabetes medication or with taking their medication?

RC: Among U.S. adults with diagnosed diabetes who were prescribed medication in the past 12 months, the percentages of adults who did not take their medication as prescribed to reduce their prescription drug costs were highest among women and adults under age 65.  Among adults aged 18-64, those who were uninsured (35.7%) were more than twice as likely than those with either private (14.0%) or Medicaid (17.8%) coverage to not take their medication as prescribed to save money.


Q: Any other significant points you’d like to make about your report?

RC: Among adults aged 18-64, those who were uninsured (35.7%) were more than twice as likely than those with either private (14.0%) or Medicaid (17.8%) coverage to not take their medication as prescribed to save money.

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Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016

May 31, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.”

Q: Why did you decide to focus on opioids prescribed at discharge or given during emergency department visits in the United States for this report?

AR:

Prescription opioid abuse and overdose continue to be critical public health issues. Opioid misuse, abuse, and overdose are affected by multiple factors including the number of people exposed. The Emergency Department (ED) is one setting where people could become exposed to opioids. In 2016, 27.5% of adult ED visits included opioids given in the ED, prescribed at ED discharge, or both (data not shown in report). The ED setting is where people frequently receive their first opioid treatment, after which patients with moderate to severe pain are often sent home with a prescription for an opioid, leaving them with the option of filling/not filling the prescription, or diverting filled prescriptions.

In the National Hospital Ambulatory Medical Care Survey (NHAMCS), information is collected on whether drugs are given during the ED visit, prescribed at discharge, or both.  However, in our published reports, the focus is on estimates of drugs and visits with drugs rather than how they are administered.  I wanted to assess visits with opioids prescribed at discharge separately to see how they compared with those given in the ED, in order to glean new information that has not previously been reported.  This could hopefully provide additional insight into patient populations visiting the ED who are exposed to opioids.


Q: How do rates of visits with opioids only given in the ED compare with opioids only prescribed at discharge and visits with both given and prescribed opioids?

AR: Generally, the rate of ED visits with opioids given during the visit was higher than the rate of ED visits with opioids prescribed at discharge.  Compared with the rate of ED visits with opioids prescribed at discharge, the rate where opioids were only given in the ED was higher among patients aged 45 and over and for both women and men.  Adults aged 18-44 were more likely to receive a prescription for an opioid at discharge compared with adults 45 and over.


Q: How did the data vary by emergency department visits where opioids were given, prescribed or both by primary diagnosis?

AR: The type of opioid administration among ED visits where opioids were given, prescribed, or both varied for certain selected diagnoses. For visits with a primary diagnosis of injury or trauma with opioids given or prescribed, the percentage with opioids only prescribed at discharge (40.7%) was higher than both the percentage of visits with opioids only given at the ED visit (26.3%) and visits with opioids both given and prescribed at discharge (32.7). Conversely, at visits for chest pain and abdominal pain with opioids given and/or prescribed, a higher percentage of opioids were only given at the ED visit. There was no variation across the types of opioid administration for back pain and extremity pain.


Q: Was there a specific finding in your report that surprised you?

AR:I was surprised at the high percentages of visits with opioids prescribed at discharge compared with those only given in the ED for certain diagnoses.  For example, among visits with a primary diagnosis of injury or trauma and where opioids were given or prescribed, a total of 73.4% included an opioid prescription at discharge.  Among visits primarily for extremity pain and where opioids were given or prescribed, 67.9% included an opioid prescription at discharge. Finally, among visits primarily for back pain in which opioids were given or prescribed, 64.5% included an opioid prescription at discharge. However I should also note that these estimates are based only on visits where the patient got opioids during the visit or at discharge.  For example, there are other ED visits made for injury where the patient did not get opioids at all, but we did not assess this in the report.


Q: Do you foresee the number of prescription opioids at emergency department visits increasing in the future?

AR: We do not make predictions about future data trends, but other research published by CDC for recent years showed stable or declining trends in the percentage of visits with opioids given in the ED, prescribed at discharge, or both.


Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

May 22, 2019

Questions for Robin Cohen, Ph.D. and Lead Author of “Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

Q: Why did you decide to do a report on strategies used to reduce prescription drug costs in the United States?

RC: Although most adults aged 65 and over have prescription drug coverage through either Medicare Part D or some other source such as private health insurance Medicaid, or VA coverage, previous data indicate that some older adults may still use strategies to reduce prescription drug costs including not taking medication as prescribed or asking their doctor for a lower cost medication.


Q: Do you have data that directly corresponds with this report that goes back further than 2016-2017?

RC: We previously examined this topic using the 2013 National Health Interview Survey. However, this previous report was not solely focused on adults aged 65 and over.


Q: How did the data vary by age, sex and insurance coverage?

RC: In 2016–2017, among U.S. adults aged 65 and over who were prescribed medication in the past 12 months, the percentage who did not take their medication as prescribed or asked their doctor for a lower-cost medication to reduce their prescription drug costs varied by sex, age, insurance status, and poverty status. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.


Q: Was there a specific finding in your report that you did not expect?

RC: No, the findings in this report were similar to those previously published with earlier data. However in this report we were able to expand on previous research by focus on adults aged 65 and over and examine differences by sex, age group, health insurance status, and poverty status.


Q: What is the take home message for this report?

RC: Among adults aged 65 and over who were prescribed medication in the past 12 months, 4.8% did not take their medication as prescribed to reduce their prescription drug costs, and 17.7% asked their doctor for a lower-cost medication. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.

 


Prescription Drug Use in the United States, 2015–2016

May 8, 2019

Questions for Lead Author Crescent Martin, Health Statistician, of “Prescription Drug Use in the United States, 2015–2016.”

Q: Why did you decide to do a report on prescription drug use in the United States?

CM: We wanted to update a previous report that found an increase in prescription drug use from 1999–2000 through 2007–2008, using the latest available data from 2015–2016.


Q: Do you have data for the years between 2007-2008 and 2015-2016 on prescription drug use?

CM: Yes, the trends analysis (shown in Figure 4) includes an estimate for each two-year survey cycle from 2007–2008 through 2015–2016 (i.e. 5 time points over the decade.)


Q: How did the data vary by age, sex and race?

CM: The percentage of the population that used prescription drugs increased with age among every group we looked at: overall, among both males and females, and among each race and Hispanic origin group.

By sex, prescription drug use was higher among females than males, though this overall difference was primarily driven by the difference observed among adults aged 20–59. Among children age 11 and younger, a higher percentage of boys than girls used prescription drugs.

Prescription drug use was highest among Non-Hispanic white persons, followed by non-Hispanic black persons, and was lowest among non-Hispanic Asian and Hispanic persons. This pattern also varied by age, and among adults aged 60 and over no differences were observed between race and Hispanic origin groups.


Q: Was there a specific finding in your report that surprised you?

CM: I was interested to see the different types of prescription drugs that were most commonly used within each age group. The most commonly used types of prescription drugs were bronchodilators (such as asthma rescue inhalers) for children aged 11 and under, central nervous system stimulants for adolescents aged 12-19, antidepressants for adults aged 20-59, and cholesterol-lowering drugs for adults aged 60 and over.

The top drug type for each age group was actually the same drug type that was most commonly used in 2007–2008, from the earlier report.


Q: What is the take home message for this report?

CM: Overall, almost half of the U.S. population took one or more prescription drugs in the past 30 days during 2015–2016.

When we look at trends over time and take into account how the age distribution of the US population has gotten older over this decade, we see a decline in the use of prescription drugs from 2007–2008 through 2015–2016.