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Sumit R. Majumdar, MD, MPH, FRCPC

Arch Intern Med. 2009;169(8):748-749.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Cost-related nonadherence (CRN) is common, and one-third of older adults take less medication than prescribed to reduce out-of-pocket costs.¹ Common strategies to reduce out-of-pocket costs include splitting pills, skipping doses, or delaying refills, all secondary forms of nonadherence.¹ Less attention has been paid to "primary" nonadherence, ie, not even filling the prescription. This strategy is the most effective way to reduce out-of-pocket costs, and primary nonadherence is practiced by 10% to 20% of patients.²

Short of a randomized trial, the best way to understand the effect of out-of-pocket costs on primary or secondary nonadherence would be to undertake a large longitudinal study of older insured patients who are "exposed" to drug benefit plans of differing generosities and who go on to develop an incident diagnosis of a chronic condition that requires new treatment and then to measure the receipt of a prescription (under control . . . [Full Text of this Article]

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