Unaffordable medication is one of the primary reasons older adults do not adhere to treatment regimens in the United States, and IMPAQ researchers have found evidence that increasing access to the Supplemental Nutrition Assistance Program (SNAP) may lead to reduced rates of nonadherence.
The findings of this study were published in the February 2018 issue of the American Journal of Public Health 
Lead author and co-principal investigator, Mithuna Srinivasan, Ph.D, the lead author and co-principal investigator of the study, and a Research Associate in the Workforce Development Division, explained why a food assistance program may help older adults with a seemingly unrelated challenge.
“The high cost of prescription medication can lead to tradeoffs between medication and other necessities, such as food or utilities. This, in turn, can manifest as cost-related nonadherence (CRN), including such behaviors as skipping or stopping medications due to cost. While SNAP’s primary goal is to improve access to food, we wanted to test whether the program might help older adults better afford their prescription medications, conceivably by reducing out-of-pocket expenditures on food,” Srinivasan, a mixed-methods researcher who works across diverse topic areas spanning food and nutrition, workforce development and health, observed.
The study found that even after controlling for important predictors of CRN such as health conditions, out-of-pocket health care costs, and prescription drug coverage, on average, SNAP participants were 4.8% less likely to engage in CRN than eligible nonparticipants (P < .01). SNAP participation had an even greater impact for older adults threatened by hunger (9.1%; P < .01) and who were food insecure (7.4%; P < .05).
The researchers concluded that these findings suggest that increasing access to SNAP may allow low-income older adults to better afford their prescription medications, which is important, not only for their health and well-being, but for reducing costly consequences of nonadherence
CRN not elimitated
“However, it’s important to note that while SNAP reduced CRN among participants, it did not eliminate CRN entirely – more efforts are needed to overcome the financial barriers to medication adherence than SNAP can address on its own,” Jennifer Pooler, the study co-author and co-principal investigator, a Senior Research Associate in IMPAQ Health’s Advanced Analytics team, explained.
These results have many policy implications for state and Federal governments, as well as health insurance payers and health systems. States and the Federal government must continue to reduce barriers to SNAP participation for older adults: only about 40-45 percent of eligible, low-income older adults participate in the program.
Stakeholders can also reduce the stigma associated with SNAP participation by touting the “health benefits” of participation and reframing the program as a health subsidy.
Based on the outcome of the study, the authors feel that health plan sponsors, government payers, and health systems should also explore opportunities to screen for food insecurity and refer food-insecure older adult patients to community-based organizations that can help those individuals access SNAP and other resources for which they may be eligible.
Finally, health plan sponsors and government payers can reimburse health systems for food security screening and referrals.
Last Editorial Review: January 19, 2018
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