Prescription drug benefits and use of guideline recommended medications by elderly Medicare beneficiaries with diabetes mellitus

UMMS Affiliation

Division of Geriatric Medicine

Publication Date


Document Type



Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Drug Utilization; Female; Guideline Adherence; Health Benefit Plans, Employee; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; *Insurance Coverage; Insurance, Medigap; *Insurance, Pharmaceutical Services; Male; Medicaid; *Medicare; Practice Guidelines as Topic; Receptors, Angiotensin; United States; United States Department of Veterans Affairs


Life Sciences | Medicine and Health Sciences


OBJECTIVES: To determine whether prescription drug benefits are associated with the use of guideline recommended medications by older persons with type 2 diabetes mellitus (DM).

DESIGN: Cross-sectional study.

PARTICIPANTS: A national sample of Medicare beneficiaries with DM aged 65 and older and an indication for angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) use or high risk of coronary heart disease (hypertension or current smoking) who participated in the 2003 Medicare Current Beneficiary Survey.

MEASUREMENTS: Prescription drug coverage was measured according to self-report and verified according to insurance claims. Outcome variables were use of an ACEI or an ARB (ACEI/ARB) or a statin or use of an ACEI/ARB and a statin. Survey-weighted multinomial logistic regression was used to identify the independent effect of drug coverage on one of two categories of recommended medication use (ACEI/ARB or statin or ACEI/ARB and statin) compared with the reference category of none after controlling for sociodemographic characteristics and health status.

RESULTS: The final study sample was 1,181 (weighted N=4.0 million). Overall, 23% had no drug coverage, 16% Medicaid coverage, 43% employer coverage, 9% Medigap coverage, and 9% Department of Veterans Affairs (VA) or state-sponsored low-income coverage. Overall, 33% received a statin and an ACEI/ARB, 44% only an ACEI/ARB or a statin, and 23% neither. After adjustment, VA and state-sponsored drug benefits were most strongly associated with combined ACEI/ARB and statin use (relative risk ratio (RRR)=4.83, 95% confidence interval (CI)=2.24-10.4)), followed by employer-sponsored coverage (RRR=2.60, 95% CI=1.67-4.03)).

CONCLUSIONS: Prescription drug benefits from VA and state-sponsored drug programs are strongly associated with use of recommended medications by older adults with DM.

DOI of Published Version



J Am Geriatr Soc. 2008 Oct;56(10):1879-86. Epub 2008 Sep 2. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Geriatrics Society

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Link to Article in PubMed

PubMed ID