All Children Left Behind: Parental Inattention and Drug Adherence

Motivation

Drug regimens are important for the maintenance of chronic disease. Some popular press articles conjectured that adherence to prescription drugs went down during the COVID-19 pandemic, which could have long-run implications for health outcomes.

We obtained comprehensive data on U.S. prescription drug claims from 2018 to 2020 to test this hypothesis and to learn more about the mechanisms driving drug adherence.

Average Responses

There was stockpiling behavior in March 2020
Adult adherence remains higher relative to previous years throughout 2020
Pediatric adherence drops significantly, almost 30 percent in the youngest children by December 2020
- This is similar in magnitude to responses to major changes to insurance plan design documented in the literature

Mechanisms

We find very little heterogeneity across regions and by insurance status
- This includes looking at SES measures, changes in air quality, school closures, and telehealth policies
We then bring in complementary data from the Medical Expenditure Panel Survey (MEPS) that links children to parental measures
- We find that the strongest moderators are parents filling scripts (particularly asthma scripts)

Implications

Adult adherence went up during the pandemic, while pediatric adherence went down significantly
The drop for children was similar across geographic regions and by insurance status
Parental attention matters for adherence to medication in the youngest children, which speaks to the SES gradient literature
Pharmacies and policymakers could potentially introduce tools to help parents manage their children's treatments