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Impact of the Patient Protection and Affordable Care Act on cost‐related medication underuse in nonelderly adult cancer survivors
Author(s) -
Barnes Justin M.,
Johnson Kimberly J.,
Adjei Boakye Eric,
Sethi Rosh K. V.,
Varvares Mark A.,
OsazuwaPeters Nosayaba
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32836
Subject(s) - medicine , confidence interval , cancer , poverty , health care , patient protection and affordable care act , gerontology , health insurance , demography , sociology , economics , economic growth
Background Cost‐related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors. Methods Using National Health Interview Survey data (2011‐2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011‐2013) to after (2015‐2017) implementation of the ACA. Difference‐in‐differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low‐income versus high‐income cancer survivors, and nonelderly versus elderly cancer survivors. Results A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33‐percentage point (PP) (95% confidence interval, 3.06‐13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income <250% of the federal poverty level (FPL) compared with those with income >400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income <400% of the FPL (−9.35 PP; 95% confidence interval, −15.6 to −3.14 PP [ P = .003]). Conclusions There was an ACA‐associated reduction in CRMU noted among low‐income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population.