Elderly/Long-term Care

Study examines the impact of Medicare Part D on drug adherence among the elderly

Medicare coverage of prescription drugs through Medicare Part D was designed to reduce the financial burden of life-saving medicines taken by the elderly, many of whom were cutting back on pills or not refilling prescriptions to save money. Not adhering to drug regimens due to concerns about cost declined somewhat following Part D implementation, although not among the sickest Medicare beneficiaries.

This study of a nationally representative group of Medicare beneficiaries found that implementation of the Medicare Part D drug plan was associated with a small, but significant, decrease in the prevalence of cost-related medication nonadherence (CRN). Nearly a year after implementation of Medicare Part D, the prevalence of CRN had declined by about 15 percent, and spending less on basic needs to afford medicines declined by approximately 40 percent compared with prior years.

While CRN did not decrease among individuals who were seriously ill, they did report reductions in foregoing basic needs to afford medication that were similar to those among beneficiaries in good to excellent health. The modest benefit of Part D was predictable, given that the sample included all noninstitutionalized Medicare beneficiaries, regardless of whether they enrolled in Part D. Less healthy beneficiaries who did enroll in a Part D plan would have paid substantially more in copayments (due to intensive use of medication) than other beneficiaries. Thus, they would more likely have experienced the "doughnut hole" coverage gap, in which they would pay 100 percent of copayments after the first $2,250 in total drug costs until they spent $3,600 out-of-pocket.

The findings suggest that the intensive medicine needs and financial barriers to prescription drug access among the sickest Medicare beneficiaries may not have been fully addressed by Part D. The findings were based on analysis of the Medicare Current Beneficiary Surveys in 2004, 2005, and 2006 (before and after Medicare Part D implementation). The researchers compared self-reports of CRN (skipping or reducing doses, not filling prescriptions) and spending less on basic needs to afford medicines before and after implementation of the Part D drug plan. This study was supported in part by a grant to the HMO Research Network Center for Education and Research on Therapeutics (CERT) from the Agency for Healthcare Research and Quality (HS10391).

For more information on the CERTs program, go to http://www.ahrq.gov/clinic/certsovr.htm.

Details are in "Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D," by Jeanne M. Madden, Ph.D., Amy J. Graves, M.P.H., Fang Zhang, Ph.D., and others, in the April 2008 Journal of the American Medical Association 299(16), pp. 1922-1928.

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