Chronic Disease

Indigent patients with diabetes who get free medications have lower blood-sugar levels

Low-income patients are twice as likely to not take all their medications as other patients because they often cannot afford them, and patients with diabetes can have higher-out-of-pocket medication costs than patients with other diseases. A State medication assistance program (MAP) that provided free outpatient medications to indigent patients with diabetes resulted in lower blood-sugar levels (indicative of better diabetic control) among those who took the medications, especially those who took their medications as directed all the time (complete adherence).

Researchers retrospectively compared pre-MAP and post-MAP HbA1c (blood-glucose) levels for 289 patients (average age of 59 years) with type 2 diabetes both before and after MAP enrollment. MAP participants had a mean decline of 0.60 percent in HbA1c levels. However, effectiveness depended on how many refills they completed (level of medication adherence). Never getting a refill led to no change in HbA1c, while complete adherence led to an estimated decline of 0.88 percent in HbA1c, a clinically significant drop in blood-sugar levels.

These findings suggest that, even when medications are free to patients, other types of patient costs exist that may restrict access. For example, this MAP now refills prescriptions for longer time periods (greater than one month) in order to mitigate the effect of transportation costs and other hidden patient costs on refill behavior on low-income groups. The study was supported in part by the Agency for Healthcare Research and Quality (HS11834).

See "Diabetes mellitus medication assistance program: Relationship of effectiveness to adherence," by Ronald L. Horswell, Ph.D., Charles K. Wascom, R.Ph., Frederick P. Cerise, M.D., M.P.H., and others, in the Journal of Health Care for the Poor and Underserved 19, pp. 677-686, 2008.

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