Nearly 5 percent of adults over age 65 said they rationed medication, skipped doses or didn’t fill a prescription in an effort to control their prescription drug costs, according to a new data brief from the National Center for Health Statistics. Women, seniors under age 74, those covered by Medicare only, and those just above the poverty line were the most likely to take this approach to coping with high drug costs, researchers found.

The context

Almost two thirds of adults over age 65 have at least two chronic conditions, potentially exposing them to high prescription drug costs for maintenance medications.

But rationing medication can have serious health implications. Researchers noted that lack of medication adherence has been associated with increased emergency room use and hospitalizations.

The data

Researchers Robin A. Cohen and Peter Boersma used data from the 2016-2017 National Health Interview Study to analyze strategies for reducing out-of-pocket prescription drug costs among seniors. Researchers looked specifically at individuals who did not take their medication as prescribed and who asked their doctor for a lower-cost alternative.

The results

Among adults age 65 and older who were prescribed a medication in the past 12 months, 4.8 percent did not take it as prescribed, in an effort to reduce their expenses. Another 17.7 percent asked their doctor for a lower-cost alternative. But strategies varied by gender, age, insurance coverage and poverty status:

By gender

Women were more likely than men to try to reduce their prescription drug costs.

By age

Adults between ages 65 and 74 were also more likely than those over age 74 to try to save money on prescription drugs.

By insurance coverage

Those with Medicare only were more likely than those with Medicare Advantage, Medicare and Medicaid, or private coverage to not take their medication as prescribed.

Medicare Advantage plans and private insurance typically include drug coverage, whereas people who have original Medicare may purchase a separate Part D plan to pay for medications.

People who are dual-eligible, meaning they qualify for both Medicare and Medicaid, can get drug coverage through Medicaid.

By economic status

Low-income seniors were more likely than higher income seniors to not adhere to medication instructions.

Researchers defined “poor” as seniors within 100 percent of the poverty level, which was an income of $11,880 in 2017 for an individual. “Near poor” was defined as income 100-200 percent of the poverty level, which was an income of no more than $23,760 in 2017 for an individual.

The caveats

The type of medication patients need influences its cost; however, the study did not analyze what types of medications people who used cost-saving strategies were taking because the National Health Interview Survey does not ask that question.

The funding

The National Center for Health Statistics is part of the U.S. Centers for Disease Control and Prevention.