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. ### Competing Interest Statement M Law has consulted for Health Canada and Health Employees Union and the Conference Board of Canada and provided expert witness testimony for the Attorney General of Canada and the Federation of Post-Secondary Educators. N Khalidi reports receiving research support on unrelated topics from Roche and BMS and Abbvie and Sanofi. ### Funding Statement The study was funded through a Canadian Institute of Health Research grant titled Cost related Non-adherence to prescription drugs; A Multi-Method Study (PI, Michael Law) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of Hamilton Integrated Research Ethics Board (HiREB) gave ethical approval for this work (HiREB #11-077). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript.