LAUSR

Patient out of pocket (OOP) cost play considerable roles in the prescribing decision-making process. Approximately 20% of older adults experience cost related nonadherence (CRN), where inability to afford OOP cost lead to lower rates of medication use and resultant poor health outcomes, including 15% higher all-cause mortality, 33% increase in hospitalizations, and increased total cost of care.1–4 For older adults, comorbidities that necessitate use of multiple medications, and low individual and household income increases the risk of CRN. Furthermore, the structure of Medicare and Part D can contribute to the risk for CRN due to increased cost sharing in the coverage gap. Entry into the coverage gap can be delayed or prevented by intentional prescribing of medications with lower total costs; however, lower cost medications do not always align with guidelines, leading to a prescribing dilemma for clinicians. In this commentary, we utilize a patient case to spotlight the interplay between guideline-concordant prescribing and CRN within older adults and explore potential solutions and areas for additional research.