Prescription drug coverage, health, and medication acquisition among seniors with one or more chronic conditions
Meyers Primary Care Institute; Department of Family Medicine and Community Health
Medical Subject Headings
Aged; Aged, 80 and over; Chronic Disease; Cross-Sectional Studies; Diabetes Mellitus; Female; Health Care Surveys; *Health Status; Humans; Insurance Coverage; Insurance, Pharmaceutical Services; Male; Medicare Part C; Multivariate Analysis; Self Administration; Socioeconomic Factors; Washington
Health Services Research | Pharmacy and Pharmaceutical Sciences | Primary Care
BACKGROUND: The unabated rise in medication costs particularly affects older persons with chronic conditions that require long-term medication use, but how prescription benefits affect medication adherence for such persons has received limited study.
OBJECTIVE: We sought to study the relationship among prescription benefit status, health, and medication acquisition in a sample of elderly HMO enrollees with 1 or more common, chronic conditions.
RESEARCH DESIGN: We implemented a cross-sectional cohort study using primary survey data collected in 2000 and administrative data from the previous 2 years.
SUBJECTS: Subjects were aged 67 years of age and older, continuously enrolled in a Medicare + Choice program for at least 2 years, and diagnosed with 1 or more of hypertension, diabetes, congestive heart failure, and coronary artery disease (n = 3073).
MEASURES: Outcomes were the mean daily number of essential therapeutic drug classes and refill adherence.
RESULTS: In multivariate models, persons without a prescription benefit acquired medications in 0.15 fewer therapeutic classes daily and experienced lower refill adherence (approximately 7 fewer days of necessary medications during the course of 2 years) than those with a prescription benefit. A significant interaction revealed that, among those without a benefit, persons in poor health acquired medications in 0.73 more therapeutic classes daily than persons in excellent health; health status did not significantly influence medication acquisition for those with a benefit.
CONCLUSIONS: Coverage of prescription drugs is important for improving access to essential medications for persons with the studied chronic conditions. A Medicare drug benefit that provides unimpeded access to medications needed to treat such conditions may improve medication acquisition and, ultimately, health.