Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D.
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine; Graduate School of Biomedical Sciences, Clinical and Population Health Research Program
Medical Subject Headings
Aged; Aged, 80 and over; Drug Costs; Drug Utilization; Female; Financing, Personal; Health Surveys; Humans; Logistic Models; Male; Medical Indigency; Medicare Part D; Middle Aged; Socioeconomic Factors; Treatment Refusal; United States
Health Services Research | Medicine and Health Sciences
CONTEXT: Cost-related medication nonadherence (CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare prescription drug coverage (Part D) on CRN is unknown.
OBJECTIVE: To estimate changes in CRN and forgoing basic needs to pay for drugs following Part D implementation.
DESIGN, SETTING, AND PARTICIPANTS: In a population-level study design, changes in study outcomes between 2005 and 2006 before and after Medicare Part D implementation were compared with historical changes between 2004 and 2005. The community-dwelling sample of the nationally representative Medicare Current Beneficiary Survey (unweighted unique n = 24,234; response rate, 72.3%) was used, and logistic regression analyses were controlled for demographic characteristics, health status, and historical trends.
MAIN OUTCOME MEASURES: Self-reports of CRN (skipping or reducing doses, not obtaining prescriptions) and spending less on basic needs to afford medicines.
RESULTS: The unadjusted, weighted prevalence of CRN was 15.2% in 2004, 14.1% in 2005, and 11.5% after Part D implementation in 2006. The prevalence of spending less on basic needs was 10.6% in 2004, 11.1% in 2005, and 7.6% in 2006. Adjusted analyses comparing 2006 with 2005 and controlling for historical changes (2005 vs 2004) demonstrated significant decreases in the odds of CRN (ratio of odds ratios [ORs], 0.85; 95% confidence interval [CI], 0.74-0.98; P = .03) and spending less on basic needs (ratio of ORs, 0.59; 95% CI, 0.48-0.72; P < .001). No significant changes in CRN were observed among beneficiaries with fair to poor health (ratio of ORs, 1.00; 95% CI, 0.82-1.21; P = .97), despite high baseline CRN prevalence for this group (22.2% in 2005) and significant decreases among beneficiaries with good to excellent health (ratio of ORs, 0.77; 95% CI, 0.63-0.95; P = .02). However, significant reductions in spending less on basic needs were observed in both groups (fair to poor health: ratio of ORs, 0.60; 95% CI, 0.47-0.75; P < .001; and good to excellent health: ratio of ORs, 0.57; 95% CI, 0.44-0.75; P < .001).
CONCLUSIONS: In this survey population, there was evidence for a small but significant overall decrease in CRN and forgoing basic needs following Part D implementation. However, no net decrease in CRN after Part D was observed among the sickest beneficiaries, who continued to experience higher rates of CRN.
Rights and Permissions
Citation: JAMA. 2008 Apr 23;299(16):1922-8.
Madden, Jeanne M.; Graves, Amy J.; Zhang, Fang; Adams, Alyce S.; Briesacher, Becky A.; Ross-Degnan, Dennis; Gurwitz, Jerry H.; Pierre-Jacques, Marsha; Safran, Dana Gelb; Adler, Gerald S.; and Soumerai, Stephen B., "Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D." (2008). Meyers Primary Care Institute Publications and Presentations. 37.