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High Out-of-Pocket Costs Increase Medication Nonadherence Among Patients With RA

June 06, 2019

By Julie Gould

parvaneh heidariParvaneh Heidari, PhD student at Monash University, explains why it is recommended that health policy makers globally identify the appropriate out-of-pocket amount, so these costs do not affect medication adherence among patients with rheumatoid arthritis.

Please tell us a little about yourself and research interests.

In 2015, I got a scholarship from Monash University and started my PhD in November 2015, and at the moment I am writing my thesis and will submit it in July 2019. My PhD project was about medication adherence in patients with RA. A mixed-method approach including the survey of patients and interviews with rheumatologists was conducted for this project.

Can you briefly highlight how non-adherence impacts the out-of-pocket costs? Does the cost of treatment drive non-adherence?

Medication out-of-pocket (OOP) costs were found as barriers to medication adherence. Biologic disease-modifying anti-rheumatic drugs (bDMARDs) were a revolution in treatment of numerous diseases such as autoimmune diseases. However, they are expensive in comparison with the conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) that limits the utilization of these effective medications. With the widespread use of bDMARDs, this issue is exacerbated, especially in countries where bDMARDs are not covered sufficiently by health insurance based on the people’s socioeconomic level. Noteworthy that, even with a good coverage by health insurance, people with low level of socioeconomic status have difficulty purchasing both csDMARDs and bDMARDs.

Why is non-adherence common among patients with RA? How can clinicians help improve adherence?

Despite great advances in RA medications, medication non-adherence is prevalent among patients with RA because of numerous reasons. The determinants of non-adherence are patients-, physician-, and health system-related. Therefore, to enhance adherence, multi-level interventions are recommended. Physicians play an important role in improving medication adherence by providing information, addressing patients’ perceptions about medication, and establishing trust in their relationship with their patients.

What can payers and drug manufactures take away from your study findings?

As OOP costs can contribute to non-adherence, it is recommended that health policy makers globally identify the appropriate OOP amount so these costs do not affect adherence whilst ensuring that costs are tolerable for governments, providers and insurers.


Heidari P, Cross W, Weller C, Nazarinia M, Crawford K. Medication adherence and cost-related medication non-adherence in patients with rheumatoid arthritis: A cross-sectional study [published online March 28, 2019]. Int J Rheum Dis. 2019 Apr;22(4):555-566. doi: 10.1111/1756-185X.13549

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