Nutrition Assistance Program Lowers Cost-Related Medication Nonadherence in Diabetes
The Supplemental Nutrition Assistance Program (SNAP) is the largest food safety net program in the United States, providing food assistance to households in need.
Older adults with diabetes who participate in the Supplemental Nutrition Assistance Program (SNAP) are significantly less likely to report cost-related medication nonadherence compared with nonparticipants, according to study results published in JAMA Internal Medicine.
Based on a sample of 1385 adults (≥65 years) who participated in the National Health Interview Survey (NHIS) from 2013 through 2016, investigators conducted a repeated cross-sectional, population-based study. The sample was restricted to patients diagnosed with diabetes or borderline diabetes who were prescribed medications and reported having out-of-pocket healthcare expenses in the previous year. Variables used to indicate nonadherence due to cost included delays in filling a prescription, taking less medication, and/or skipping medication doses to save money. Investigators analyzed the differences between matched groups of SNAP participants and eligible nonparticipants, controlling for individual- and household-level demographic and socioeconomic characteristics.
Key findings included a 5.3 percentage point decrease (95% CI, 0.5-10.0; P =.03) in the likelihood of SNAP participants to engage in cost-related medication nonadherence compared with eligible nonparticipants. Cost-related medication nonadherence for older adults with diabetes and prescription drug coverage who participated in SNAP was 5.8 percentage points lower (95% CI, 0.6-11.0; P =.03) compared with nonparticipants. There was no difference in cost-related medication nonadherence found between older adults without prescription drug coverage. SNAP participation was associated with a 6.4 percentage point decrease (95% CI, 0.8-11.9; P =.02) in cost-related medication nonadherence for individuals with <$500 in out-of-pocket medical costs for the previous year.
Limitations to the study design included the cross-sectional nature of NHIS data and possible underreporting of participation in SNAP, which could bias results through the inclusion of underreporting individuals in the comparison group. Researchers also did not consider other reasons for medication nonadherence and noted their inability to control for unobserved confounders that might be implicated in SNAP participation and cost-related medication nonadherence (eg, other channels of public assistance).
Overall, the findings suggest that the financial resources provided by SNAP to purchase food may also reduce cost burdens and improve overall health in program participants by making it more feasible to afford medications. The researchers suggest several avenues for further study, including “whether modest increases in SNAP benefit allocations could return health care cost savings through better management of chronic diseases.”
Pooler JA, Srinivasan M. Association between supplemental nutrition assistance program participation and cost-related medication nonadherence among older adults with diabetes [published online November 19, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5011