Observational studyHealth services research2018
Effect of Out-of-Pocket Cost on Medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE).
Observational study in Health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it, 80 citations in OpenAlex.
- Cost-sharing and adherence, clinical outcomes, health care utilization, and costs: A systematic literature review.Journal of managed care & specialty pharmacy · 2023Pooled it
- Insulin Access and Affordability Working Group: Conclusions and Recommendations.Diabetes care · 2018Guideline
- Long-term comparative effectiveness of once-weekly semaglutide versus alternative treatments in a real-world US adult population with type 2 diabetes: a randomized pragmatic clinical trial.BMJ open diabetes research & care · 2025Trial
- Trends in annual medication possession in older adults with type 2 diabetes.Journal of managed care & specialty pharmacy · 2026Article
- Financial incentives increase uptake and perceived effectiveness of autonomous medical AI, yet patients still seek human reconfirmation.NPJ digital medicine · 2026Article
- Behavioral and Lifestyle Determinants of Poor Glycemic Control Among Adults with Type 2 Diabetes in Lesotho: Implications for Public Health in Low-Resource Settings.International journal of environmental research and public health · 2025Article
- Article
- Prescription Use and Spending After the Introduction of a Real-Time Prescription Benefit Tool.JAMA network open · 2025Article
- Frequency of first generic drugs approved through "skinny labeling," 2021 to 2023.Journal of managed care & specialty pharmacy · 2025Article
- Overcoming Financial Barriers to Optimal Guideline-Directed Medical Therapy for Patients With Heart Failure.JACC. Case reports · 2025Article
- Evaluating Financial Incentives as a Tool to Increase Medication Adherence for Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2025Article
- Association between catastrophic health expenditure and mortality in older people in 11 European health systems: a longitudinal analysis between 2006 and 2020.BMJ public health · 2025Article
- Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Review
- The Association Between Type of Insurance Plan, Out-of-Pocket Cost, and Adherence to Antihypertensive Medications in Medicare Supplement Insurance Enrollees.American journal of hypertension · 2024Article
- Assessment of the utilization of real-time prescription benefits for patient cost savings within an outpatient setting.Exploratory research in clinical and social pharmacy · 2024Article
- Race and ethnicity and pharmacy dispensing of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes.Lancet regional health. Americas · 2024 · on this mapArticle
- Evaluation of 340B prescription assistance program on healthcare use in chronic obstructive pulmonary disease.Exploratory research in clinical and social pharmacy · 2023Article
- Prevalence and predictors of primary nonadherence to medications prescribed in primary care.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
- Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?Medical care · 2023Article
- Incidence and Predictors of Primary Nonadherence to Sodium Glucose Co-transporter 2 Inhibitors and Glucagon-Like Peptide 1 Agonists in a Large Integrated Healthcare System.Journal of general internal medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo estimate the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. DATA SOURCES/
settingElectronic health records from a large, health care delivery system for 223,730 patients with diabetes prescribed 842,899 new cardiometabolic medications during 2006-2012. STUDY
designObservational, new prescription cohort study of the effect of OOP cost on medication initiation and adherence. DATA COLLECTION: Adherence and OOP costs were based on pharmacy dispensing records and benefits. PRINCIPAL
findingsPrimary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index; 7 percent were never dispensed the new medication when OOP cost ≥$11, 5 percent with OOP cost of $1-$10, and 3 percent when the medication was free of charge (p < .0001). Higher OOP cost was also strongly associated with inadequate secondary adherence (≥20 percent of time without adequate medication). There was no clinically significant or consistent relationship between OOP costs and early nonpersistence (dispensed once, never refilled) or later stage nonpersistence (discontinued within 24 months).
conclusionsCost-sharing may deter clinically vulnerable patients from initiating essential medications, undermining adherence and risk factor control.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.