Depression and Cost-Related Medication Nonadherence in Medicare Beneficiaries

Abstract

Context: Treatment for depression can be expensive and depression can affect the use of other medical services, yet there is little information on how depression affects the prevalence of cost-related medication nonadherence (CRN) in elderly patients and patients with disabilities.

Unfilled Prescriptions of Medicare Beneficiaries: Prevalence, Reasons, and Types of Medicines Prescribed

“…This finding is broadly consistent with other Medicare studies, which find higher rates of nonadherence among adults with poor health, chronic disease, and disabilities. 18,20,23 These disparities may be explained by another factor not included in this analysisthe number of drugs prescribed. Simply put, a higher number of prescriptions presents more frequent opportunities for nonadherence, and patients with more serious chronic conditions or multiple chronic conditions are prescribed more medicines than are those without chronic conditions.…”

“…[18][19][20] Other patient attributes positively associated with cost-related nonadherence are racial or ethnic minority status, 12,17 female gender, 18 lack of health insurance or prescription drug coverage, 9,16,17,21,22 low income, 18 and disability or chronic illness. 18,23 Yet, clinicians observe that patients with similar health conditions, sociodemographic attributes, and socioeconomic status may make very different choices when it comes to filling their prescriptions. 24 These differences in adherence are often attributed to the quality of the patient-provider interactions; [25][26][27] the salient nontherapeutic features of the drugs prescribed, including the complexity of regimens; 28,29 and the occurrence of unpleasant sideeffects or drug interactions.…”

“…[38][39][40] However, it appears that more vulnerable populations, including patients with chronic conditions and low incomes, are more sensitive to cost-sharing increases or coverage limits. 38,41,42 Although a number of studies have used Medicare program data to assess rates of prescription drug nonadherence among enrollees with chronic health conditions, 4,13,14,[20][21][22][23] there have been no detailed analyses of which prescriptions were not filled. 43,44 This paper fills these research gaps and establishes baseline data prior to implementation of the new Medicare drug benefit.…”

Implementation of the Medicare Part D Prescription Drug Benefit is Associated with Antiretroviral Therapy Interruptions

“…Increasing drug costs and capping prescription benefits (Hsu et al 2006) have limited access to essential drugs, resulting in increased emergency department (ED) visits, hospitalizations, and long-term care admissions (Adams et al 2001;Cox et al 2001;Goldman et al 2007;Mojtabai and Olfson 2003;Rector and Venus 2004;Shih 1999;Tamblyn et al 2001;Tseng et al 2004). Although increased consumer cost-sharing has been shown to decrease prescription drug use and result in adverse health outcomes in chronic illnesses such as congestive heart failure (Cole et al 2006), lipid disorders (Gibson et al 2006a, b), diabetes (Mahoney 2005), depression (Bambauer et al 2007) and schizophrenia (Soumerai et al 1994), little is known about the influence of increased consumer cost-sharing on antiretroviral therapy use or clinical outcomes in HIV-infected patients.…”

Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal

“…A US internet survey found that more than 30% of active elderly reported CRN [31]. Disease itself and polypharmacy may increase the likelihood of engaging in non-adherence [32,33]. The costs of medication, prescription drug coverage, insurance coverage and income have all been reported as predictors of CRN [34,35].…”