Background: Cost-coping behaviors, including skipping doses or borrowing money, are a recognized consequence of rising medication costs. Patients with diabetes mellitus (DM) have higher annual healthcare costs; however, there is limited data comparing cost-coping decisions in patients with and without DM.

Methods: We recruited 270 adults aged 35-80 with at least one chronic health condition, one medication and concern about cost. Participants were enrolled from academic multispecialty and community primary care clinics and newspaper ads. Individual hour-long surveys covered demographics, healthcare utilization and literacy, insurance, medications and diagnoses, financial strain, and provider communication. We compared survey data from patients with (n=81) and without (n=189) DM.

Results: The sample was 59% female and 83% African American. The majority had a high school education or less and 47% made less than $800 monthly. In patients with DM, monthly self-reported medication cost was higher ($92 vs. $42, p=0.001) and more variable month to month (25% vs. 15%, p=0.05). Those with DM were less likely to have never skipped doses to cut cost (44% vs. 59%, p=0.02) and were more likely to ask for and receive free samples (52% vs. 29%, p=0.0004). They were more likely to have filed for bankruptcy (38% vs. 22%, p=0.005) and reported spending less on basic needs to pay for medications (58% vs. 42%, p=0.01). These patients spent less on food/groceries first, followed by utilities, transport, and housing. More patients with DM had ever talked with a doctor about affordability of healthcare or medications (67% vs. 49%, p=0.008) and 86% were comfortable with the discussion.

Conclusion: Patients with DM are vulnerable to rising healthcare cost and utilize cost-coping strategies that could negatively affect health; however, most report being comfortable talking to a doctor about cost. Interventions that acknowledge and address cost-coping must be incorporated in practice to improve medication adherence.


L. Hollar: None. S. Humble: None. C.J. Herrick: Stock/Shareholder; Spouse/Partner; Cardinal Health. A.S. James: None.


National Institutes of Health (R01MD010445 to A.S.J.)

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