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Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D
Jeanne M. Madden, PhD;
Amy J. Graves, MPH;
Fang Zhang, PhD;
Alyce S. Adams, PhD;
Becky A. Briesacher, PhD;
Dennis Ross-Degnan, ScD;
Jerry H. Gurwitz, MD;
Marsha Pierre-Jacques, BA;
Dana Gelb Safran, ScD;
Gerald S. Adler, MPhil;
Stephen B. Soumerai, ScD
JAMA. 2008;299(16):1922-1928.
Context Cost-related medication nonadherence (CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare prescription drug coverage (Part D) on CRN is unknown.
Objective To estimate changes in CRN and forgoing basic needs to pay for drugs following Part D implementation.
Design, Setting, and Participants In a population-level study design, changes in study outcomes between 2005 and 2006 before and after Medicare Part D implementation were compared with historical changes between 2004 and 2005. The community-dwelling sample of the nationally representative Medicare Current Beneficiary Survey (unweighted unique n = 24 234; response rate, 72.3%) was used, and logistic regression analyses were controlled for demographic characteristics, health status, and historical trends.
Main Outcome Measures Self-reports of CRN (skipping or reducing doses, not obtaining prescriptions) and spending less on basic needs to afford medicines.
Results The unadjusted, weighted prevalence of CRN was 15.2% in 2004, 14.1% in 2005, and 11.5% after Part D implementation in 2006. The prevalence of spending less on basic needs was 10.6% in 2004, 11.1% in 2005, and 7.6% in 2006. Adjusted analyses comparing 2006 with 2005 and controlling for historical changes (2005 vs 2004) demonstrated significant decreases in the odds of CRN (ratio of odds ratios [ORs], 0.85; 95% confidence interval [CI], 0.74-0.98; P = .03) and spending less on basic needs (ratio of ORs, 0.59; 95% CI, 0.48-0.72; P < .001). No significant changes in CRN were observed among beneficiaries with fair to poor health (ratio of ORs, 1.00; 95% CI, 0.82-1.21; P = .97), despite high baseline CRN prevalence for this group (22.2% in 2005) and significant decreases among beneficiaries with good to excellent health (ratio of ORs, 0.77; 95% CI, 0.63-0.95; P = .02). However, significant reductions in spending less on basic needs were observed in both groups (fair to poor health: ratio of ORs, 0.60; 95% CI, 0.47-0.75; P < .001; and good to excellent health: ratio of ORs, 0.57; 95% CI, 0.44-0.75; P < .001).
Conclusions In this survey population, there was evidence for a small but significant overall decrease in CRN and forgoing basic needs following Part D implementation. However, no net decrease in CRN after Part D was observed among the sickest beneficiaries, who continued to experience higher rates of CRN.
Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Madden, Zhang, Adams, Ross-Degnan, and Soumerai, and Mss Graves and Pierre-Jacques); Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (Drs Briesacher and Gurwitz); Department of Medicine, Tufts University School of Medicine and Blue Cross Blue Shield of Massachusetts, Boston (Dr Safran); and Office of Research, Development, and Information, Centers for Medicare & Medicaid Services, Baltimore, Maryland (Mr Adler).
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