Nashville, TN—Medications do not work unless patients take them, and pharmacists are constantly challenged to identify those who are inadequately compliant with drug regimens, often due to costs.

A new JAMA study provides some important information: Members of the lesbian, gay, bisexual, and queer communities are more likely than heterosexuals to use techniques to reduce medication costs, such as using alternative therapies, skipping medication doses, or delaying prescription refills.

That's especially a problem, according to Vanderbilt University researchers, because members of those cohorts are disproportionately affected by certain conditions such as mood disorders, HIV, and cardiovascular disease, all of which require medical therapy.

Noting that members of sexual minority populations often disproportionately face worse health outcomes compared with their heterosexual peers, the authors write, "Furthermore, patients who forgo or delay medical care and prescription medicine to save money may have worse health outcomes. While previous research has documented use of alternative therapies and cost-related medication nonadherence by race and ethnicity, no studies, to our knowledge, have examined whether adults from sexual minority groups engage in medication cost-saving strategies."

To remedy that, the study team estimated behaviors regarding medications to save money by sexual orientation using nationally representative data in United States adults from 2015 to 2018.

Using this data from the National Health Interview Survey, the researchers determined that adults from sexual minority groups were more likely to:

• reduce medication costs by using alternative therapies (8.2% vs. 4.2%)
• skip medication doses (8.0% vs. 5.8%)
• take less medication (8.4% vs. 6%)
• delay prescription refills (11.9% vs. 7.5%)
• ask a clinician for a lower cost medication (21.9% vs. 19.2%).

"These findings demonstrate a huge problem given that LGBTQ+ patients are disproportionately affected by chronic disease," stated Vanderbilt University School of Medicine student and investigator Rishub Das. "The results also highlight an opportunity to improve health outcomes for a marginalized population. If we can help patients from sexual minority backgrounds access medications, we may be able to make steps toward achieving health equity."

"This study used comprehensive controls and covariates to isolate the relationship between identifying as a sexual minority and the studied health behaviors," Das said. "In other words, there is something beyond insurance coverage in the way the healthcare system and structures of society treat sexual minority patients that creates the disparities we identified."

In the data, 114,696 respondents reported their sexual orientation as heterosexual (weighted 96.9%), lesbian or gay (1.6%), bisexual (1.1%), or other (0.4%). Respondents who did not know the answer (n = 949) or declined responding to (n = 685) the sexual orientation question were excluded.

"Results varied by subgroup. For example, bisexual individuals were more likely to delay filling a prescription to save money (15.0% vs 7.5%; absolute RD, 4.31% [95% CI, 1.85%-6.77%]; OR, 1.71 [95% CI, 1.32-2.22]) than heterosexual individuals," the authors explain.

Overall, the study found modest increases in several self-reported behaviors to reduce medication costs among sexual minority adults compared with heterosexuals. "Poor knowledge about sexual minority issues among prescribers, difficulty navigating the health care system, and disparate social and financial supports may contribute to medication cost-saving behaviors among sexual minority adults," the authors suggest. "Future studies should explore interventions to minimize such behaviors among individuals who identify as a sexual minority. This study was limited by self-reported data and the proportion of respondents without sexual orientation data."

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