CONTEXT: Understanding and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006. OBJECTIVE:To determine the prevalence of physicianpatient dialogue about medication cost and medication adherence among elderly adults nationwide. DESIGN:Cross-sectional survey.PARTICIPANTS: National stratified random sample of community-dwelling Medicare beneficiaries aged 65 and older. MAIN OUTCOME MEASURES:Rates of physicianpatient dialogue about nonadherence and cost-related medication switching.RESULTS: Forty-one percent of seniors reported taking five or more prescription medications, and more than half has 2 or more prescribing physicians. Thirty-two percent overall and 24% of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines in the last 12 months. Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy, 27% had not talked with a physician about it. Of those reporting cost-related nonadherence, 39% had not talked with a physician about it. Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug, and in a multivariable model, having had a discussion about drug cost was significantly associated with this switch (odds ratio [OR] 5.04, 95% confidence interval [CI] 4.28-5.93, P<.001). CONCLUSIONS:We show that there is a communication gap between seniors and their physicians around prescription medications. This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans. Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters.

W i t h t h e m e di c a r e drug benefit approaching its third year of operation, there is considerable interest in understanding its effects on beneficiaries' coverage, out-of-pocket spending, and access to needed medications. The Part D benefit was enacted to respond to the welldocumented problems facing beneficiaries who lacked drug coverage, particularly those with modest means or high out-of-pocket spending. 1 Since the enactment of the Medicare drug benefit, researchers and policymakers have predicted a range of outcomes and identified a number of issues that were expected to arise. 2 Thus far, the empirical evidence has focused primarily on Part D and low-income subsidy (LIS) participation rates, enrollment by plan type and benefit design, and satisfaction rates, with limited information on actual experiences. H e a l t h T r a c k i n g