Biologic DMARD Access and Medication Cost-related Nonadherence in Rheumatology Patients in Canada: A Cross-sectional Survey

Background Cost-related nonadherence to prescription medications affects many Canadians and is associated with negative self-perceptions of health. Biologic disease modifying anti-arthritic drugs (bDMARDs) are costly drugs recommended for certain patients with rheumatoid or psoriatic arthritis and ankylosing spondylitis. We investigated access and cost-related nonadherence (CRN) to bDMARDs compared to other therapies for such patients in Ontario. Methods We conducted a cross-sectional telephone survey of adult patients recruited from two academic rheumatology practices in Hamilton, Ontario, asking demographic and socioeconomic characteristics, drug plan coverage, medication cost-related cutbacks, opinions on the value of bDMARDs, and assistance with costs from health professionals. CRN was defined by patient self-report of not using or using less than prescribed amount of medication, due to cost. Results 104 patients (mean age (SD) 61(12) years) participated, including 77 (74%) women, 57 (54.8%) taking bDMARDs, and 27 (25.9%) with household income <$40,000 annually. CRN was reported by 19 (18.3%) participants with no significant difference between those taking versus not taking bDMARDs (risk difference (95% CI): -0.10 (−0.25, 0.04); p=0.19). 37 (64.9%) of those taking bDMARDs reported that they would not take them if they had to pay the full cost. Overall, few patients reported that they would ask their doctor (17.3%) or pharmacist (15.4%) for help with reducing prescription costs. Conclusion CRN prevalence was relatively high amongst these rheumatology patients despite access to public and private funding mechanisms. Patients expressed a reluctance to ask their doctor or pharmacist for help in reducing their medication costs.