Amid this year's harsh economic climate, an alarming number of people are not taking the medications they need, while others are getting more medical treatments now because they're concerned about losing their health coverage.

At least 28% of Americans said they have taken potentially dangerous actions to save money, such as not filling prescriptions, skipping dosages and cutting pills in half without the approval of their doctor, according to a recent poll by the magazine Consumer Reports.

"We were surprised by the extent to which consumers are cutting corners and the risks they're taking as a result of belt-tightening. Patients need to talk to their doctors about the cost of drugs and let them know when they have difficulty paying for prescriptions," says Dr. John Santa, director of the Consumer Reports Health Ratings Center. (Editor's note: See the June 15 EBN for more coverage on improving savings and adherence with prescription medications.)

About 25% of the patients who are not adherent say the reason is cost, according to Jack Bruner, executive vice president of strategic development and marketing for CVS/Caremark.

"If you reduce the cost to the individual, you improve adherence by 8% to 30%," he adds.

Nonadherence is particularly a problem with so-called "silent" chronic diseases, like high blood pressure and diabetes, according to Dr. Brian Solow, a family practice doctor and medical director for clinical programs at Prescription Solutions, a Costa Mesa, Calif.-based pharmacy benefit manager.

In some cases, patients don't physically feel a difference when they skip the medication, so they wrongly assume it's fine to skip it.

Untreated chronic diseases can cause problems like increased risk of heart attacks, kidney disease or vision problems — which in turn causes pain for employers in the form of increased absenteeism and presenteeism.

Prescription nonadherence also can lead to very costly interventions, such as long hospital stays and surgeries, as the condition worsens.

To promote adherence, Solow recommends giving employees information about drug efficacy, safety and potential savings from the use of generics and mail-order programs.

He also suggests telling employees to contact the pharmacy benefit manager or the drug manufacturer to find out whether they qualify for a prescription assistance program.

Bruner recommends sending refill reminders, directing employees toward preferred pharmacies, lowering copays and coinsurance for certain medications, and encouraging the use of generic drugs.

Mike Thompson, a principal at the consulting firm PricewaterhouseCoopers, recommends taking a closer look at the incentives in your health programs and aligning those incentives with getting needed medical care.

For example, some employers have waived the copays for diabetes drugs and supplies to encourage diabetic employees to keep taking their medication exactly as the doctor ordered.

"A lot of [the nonadherence] has to do with the fact that employers have moved toward increased transparency and cost-sharing. [Employees] are much more cost-conscious," says Thompson. "They're being careful about how they spend their money in health care. That may mean thinking twice about going to the doctor."

They also might think twice about refilling their medication if the copay for the refill costs $50 or $100. "We've seen a very rapid movement toward three-tier formularies. The gaps between the copays have expanded," Thompson says.

"Because of that, people are more sensitive to the relative cost of the drugs. Like the rest of the economy, it's a shift toward value."

Overall, Bruner observes, "the use of prescription drugs has flattened somewhat. We see different patterns for different medications. There are people who stopped taking their medication because of the cost."

Specifically, he has noticed a decrease in the use of brand-name drugs to treat high cholesterol, diabetes and gastric reflux, and a corresponding increase in the use of generic drugs for those conditions).

He also has noticed an increase in diabetics taking statins (to treat high cholesterol) and ACE inhibitors (to treat high blood pressure).

Uptick in claims

Employers should keep an eye on their medical and prescription claims to see whether employees are increasing their use of health care -finally getting around to doctor's visits or procedures that they had put off in the past.

During economic slumps, there is a pattern of people trying to "make sure they get things covered while they have a job and are covered," Thompson confirms.

"People are very cognizant of the value that their benefits provide, especially when they feel they might lose those benefits in the event of a lay off."

The new federal subsidy for COBRA premiums can help to alleviate that situation by reassuring employees that they will have the opportunity to continue coverage, even if they get laid off, Thompson states.

Employers should communicate with their employees about the COBRA subsidy, so they understand they don't need to "rush out and get everything done," he adds.

At times of high stress and financial crisis, employers might experience an increase in the number of employees taking medications to treat stress-related health problems.

Solow says he has seen more requests for sleep aids and antidepressants. He also has heard anecdotal evidence of an increase in abuse of painkillers and anti-anxiety drugs, like Xanax and Valium.

Some employees may be responding to layoffs, longer work hours, bigger workloads and financial losses by eating more junk food, smoking more cigarettes or drinking more beer.

Employers can counter that unhealthy trend by offering healthy food at the worksite, smoking-cessation programs and an employee assistance program.