Journal of General Internal Medicine

, Volume 22, Issue 6, pp 864–871 | Cite as

Patients At-Risk for Cost-Related Medication Nonadherence: A Review of the Literature

  • Becky A. BriesacherEmail author
  • Jerry H. Gurwitz
  • Stephen B. Soumerai
Clinical Review



Up to 32% of older patients take less medication than prescribed to avoid costs, yet a comprehensive assessment of risk factors for cost-related nonadherence (CRN) is not available. This review examined the empirical literature to identify patient-, medication-, and provider-level factors that influence the relationship between medication adherence and medication costs.


We conducted searches of four databases (MEDLINE, CINAHL, Sciences Citations Index Expanded, and EconLit) from 2001 to 2006 for English-language original studies. Articles were selected if the study included an explicit measure of CRN and reported results on covarying characteristics.

Main Results

We found 19 studies with empirical support for concluding that certain patients may be susceptible to CRN: research has established consistent links between medication nonadherence due to costs and financial burden, but also to symptoms of depression and heavy disease burden. Only a handful of studies with limited statistical methods provided evidence on whether patients understand the health risks of CRN or to what extent clinicians influence patients to keep taking medications when faced with cost pressures. No relationship emerged between CRN and polypharmacy.


Efforts to reduce cost-related medication nonadherence would benefit from greater study of factors besides the presence of prescription drug coverage. Older patients with chronic diseases and mood disorders are at-risk for CRN even if enrolled in Medicare’s new drug benefit.


medicare cost sharing patient compliance prescriptions 



This study was supported by grants RO1AG022362 and R01AG028745 from the National Institute on Aging (NIA). Drs. Briesacher, Soumerai, and Gurwitz are investigators in the HMO Research Network Center for Education and Research in Therapeutics, which receives funding from the US Agency for Healthcare Research and Quality (grant 2U18HS010391).

Conflict of Interest

Dr. Briesacher reported that she has received unrestricted research grants from and has been a consultant for Novartis Pharmaceuticals Corporation within the last 3 years. The other authors reported no conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Becky A. Briesacher
    • 1
    Email author
  • Jerry H. Gurwitz
    • 1
  • Stephen B. Soumerai
    • 2
  1. 1.Division of Geriatric Medicine and Meyers Primary Care InstituteUniversity of Massachusetts Medical School, Biotech Four, Suite 315WorcesterUSA
  2. 2.Department of Ambulatory Care and PreventionHarvard Medical School and Harvard Pilgrim Health CareCambridgeUSA

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