Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D

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; Soumerai, Stephen B.

doi:10.1001/jama.299.16.1922

Cited by 252 publications

(239 citation statements)

References 35 publications

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“…Policies that make medications more available to food-insecure households will not only ensure that they are compliant with medications, but also may increase disposable income for these families. 41,42 We add voice to suggestions for using food insecurity as a risk factor for assessing cost-related medication underuse. 13 This could potentially help increase the identification of individuals who may need assistance purchasing medications as well as improve health outcomes for individuals living in food-insecure households.…”

Section: Discussionmentioning

confidence: 99%

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

et al. 2015

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Objectives. We investigated whether nonelderly US adults (aged 18–64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. Methods. We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ2 test and multivariate logistic regression with interaction terms. Results. Bivariate and multivariate analyses showed a dose–response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. Conclusions. Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households.

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Section: Discussionmentioning

confidence: 99%

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

et al. 2015

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The introduction of the Part D program led to higher medication use rates among seniors, with recent studies indicating that other healthcare service use reductions partly offset program costs. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Most Part D enrollees' expenditures do not reach the gap threshold: 12 % of enrollees, and 19 % of those who filled at least one prescription, reached the gap in 2009, lower proportions than in previous years. 29,30 Still, enrollees who reach the gap are more likely to discontinue or reduce medication use.…”

Section: Introductionmentioning

confidence: 97%

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

et al. 2013

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BACKGROUND:Although the Medicare Part D coverage gap phase-out should reduce cost-related nonadherence (CRN) among seniors with diabetes, preferential generic prescribing may have already decreased CRN, while smaller numbers of patients using more costly branded oral antidiabetic (OAD) medications remain vulnerable to CRN. OBJECTIVE: To estimate the effects of cost sharing in the Part D standard (non-LIS) benefit on adherence to different OAD classes, comparing two classes dominated by inexpensive generic medications and two by more costly branded medications. DESIGN AND PATIENTS: Retrospective cohort study using dispensed prescription data for elderly non-LIS (N= 81,047) and LIS (low-income subsidy) (N=150,359) beneficiaries using same class OAD(s) in 2008 and 2009. Logistic regression modeled non-LIS likelihood; LIS and non-LIS patients matched using propensity outcome (N= 38,054). Logistic regression, controlling for demographic and health status characteristics, modeled effects of non-LIS coverage on 2009 OAD class adherence. MAIN MEASURES: Main outcome measures were within-class OAD coverage year adherence, with patients considered adherent when days supplied to calendar days ratio at least 0.8. KEY RESULTS: Non-LIS patients had 0.52 and 0.57 times the odds of branded-only DPP-4 Inhibitor (N= 1,812; 95 % CI: 0.43, 0.63; P<0.001) and Thiazolidinedione (TZD) (N=6,290; 95 % CI: 0.52, 0.63; P<0.001) adherence. Most patients (N=32,510; 82 %) used OADs in primarily generic classes, where we found no significant (Biguanides; N=21,377) or small differences (Sulfonylureas/Glinides [N=19,240; OR: 0.91; 95 % CI: 0.86, 0.97; P =0.002]) in adherence odds. Crude adherence rates were sub-optimal when CRN was not a factor (Non-LIS/LIS: Biguanides: 65 %/65 %; Sulfonylureas/Glinides: 66 %/ 68 %; LIS: DPP-4 Inhibitors: 66 %; TZDs: 67 %). CONCLUSIONS: Gap elimination would not affect generic, but should reduce branded OAD CRN. Branded copayments may continue to lead to CRN. Policy initiatives and benefit changes targeting both cost deterrents for patients with more complex disease and non-cost generic OAD underuse are recommended.

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Section: Editorialmentioning

confidence: 99%

“…The Medicare Part D program, a subsidized drug program, aims to significantly improve access to outpatient prescription drug benefits for millions of elderly Americans [2]. While overall utilization increased after the institution of Part D, [3] costrelated medication non-adherence (CRN) has not deceased or has even worsened among the sickest patients, including those with multiple chronic conditions, depression, and stroke survivors [4][5][6].There is robust discussion about the causes and consequences of CRN. Several risk factors for CRN have been identified, including outof-pocket payments, gender, race/ethnicity, insurance coverage, comorbidities, and mental health [7][8][9].…”

mentioning

confidence: 99%

How Intensive are Patients’ Behavior in Cost-Related Medication Non- Adherence?

Zhang¹

2017

J Gerontol Geriatr Res

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EditorialThe cost barrier to medications is a persistent and serious problem among the U.S. elderly population. Twenty-six percent of the elderly do not take medication as prescribed due to a cost barrier [1]. This is not surprising as many elderly patients depend on a small amount of fixed income from social security and struggle on a day-to-day basis to make difficult choices between meeting the basic needs of daily life and filling prescriptions. The Medicare Part D program, a subsidized drug program, aims to significantly improve access to outpatient prescription drug benefits for millions of elderly Americans [2]. While overall utilization increased after the institution of Part D, [3] costrelated medication non-adherence (CRN) has not deceased or has even worsened among the sickest patients, including those with multiple chronic conditions, depression, and stroke survivors [4][5][6].There is robust discussion about the causes and consequences of CRN. Several risk factors for CRN have been identified, including outof-pocket payments, gender, race/ethnicity, insurance coverage, comorbidities, and mental health [7][8][9]. Research has also shown that increased drug costs adversely affects health outcomes, increases resource use in hospital care and emergency department, raises downstream costs to treat, and imposes heavy avoidable health care costs on society [10][11][12]. Often, poor health leads to high out-of-pocket payments (OOPs) that results in CRN, and CRN leads to worsening health outcomes, followed by even higher OOPs and then more pervasive CRN behaviors.Thus, far the literature is strong on the overall prevalence rate of CRN (i.e. the percentage of patients who have any kind of CRN behaviors), but is relatively light on the intensity of CRN behaviors (i.e. for those with CRN, how many have multiple of such behaviors, and what combinations of such behaviors they have). Specifically, a patient can have one or more CRN behaviors: delaying filling prescription, not filling the prescriptions, skipping doses, or splitting doses in order to avoid drug costs. Those with persistent, multiple CRN behaviors will certainly have higher risk of worse health outcomes than those with occasional CRN behavior. Without distinguishing those with pervasive, persistent patterns of CRN from those with occasional CRN behaviors, we may risk targeting an overly expansive population where the intervention is less effective and more expensive. While little is known in this regard, one recent study suggests that in a population at high risk of hospitalization, there are differential levels of intensity of CRN behaviors: for example, among patients reporting CRN, 65% reported two or more CRN behaviors, while 30% reported three or more CRN behaviors, and 22% reported all four types of CRN behaviors [13]. This shows how intensive the CRN behavior is for a significant portion of patients when having cost barriers to medications, and it also suggests the opportunity to target the patients who are mostly likely to benefit from the i...

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Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D

Cited by 252 publications

References 35 publications

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

How Intensive are Patients’ Behavior in Cost-Related Medication Non- Adherence?

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