Cost-related Medication Nonadherence and Its Risk Factors Among Medicare Beneficiaries

Bibliographic Data

ID9101152
AuthorsFarrah Nekui (Northeastern University, corresponding author), Alison A Galbraith (Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston), Alison Galbraith (0000-0002-7309-5915, Harvard University), Becky A Briesacher (0000-0002-0401-1685, Northeastern University, corresponding author), Fang Zhang (0000-0001-8108-3132, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston), Stephen B Soumerai (0000-0001-6811-2496, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston), Dennis Ross-Degnan (0000-0002-0066-1242, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston), Jerry H Gurwitz (0000-0003-1630-8213, Meyers Primary Care Institute), J M Madden (0000-0001-6075-7898, Northeastern University, corresponding author)
Year2021
Volume59
Issue1
Pages13-21
Publication date2021-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001458
PMID33298705
OpenAlexW3112745029
LanguageEN
Citations received5
References cited21

BACKGROUND: Unaffordability of medications is a barrier to effective treatment. Cost-related nonadherence (CRN) is a crucial, widely used measure of medications access. OBJECTIVES: Our study examines the current national prevalence of and risk factors for CRN (eg, not filling, skipping or reducing doses) and companion measures in the US Medicare population. RESEARCH DESIGN: Survey-weighted analyses included logistic regression and trends 2006-2016. SUBJECTS: Main analyses used the 2016 Medicare Current Beneficiary Survey. Our study sample of 12,625 represented 56 million community-dwelling beneficiaries. MEASURES: Additional outcome measures were spending less on other necessities in order to pay for medicines and use of drug cost reduction strategies such as requesting generics. RESULTS: In 2016, 34.5% of enrollees under 65 years with disability and 14.4% of those 65 years and older did not take their medications as prescribed due to high costs; 19.4% and 4.7%, respectively, experienced going without other essentials to pay for medicines. Near-poor older beneficiaries with incomes $15-25K had 50% higher odds of CRN (vs. >$50K), but beneficiaries with incomes <$15K, more likely to be eligible for the Part D Low-Income Subsidy, did not have significantly higher risk. Three indicators of worse health (general health status, functional limits, and count of conditions) were all independently associated with higher risk of CRN. CONCLUSIONS: Changes in the risk profile for CRN since Part D reflect the effectiveness of targeted policies. The persistent prevalence of CRN and associated risks for sicker people in Medicare demonstrate the consequences of high cost-sharing for prescription fills

Family medicine · Medical prescription · Medicare Part D · Medication adherence · MEDLINE · Prescription drug · Economic and Financial Impacts of Cancer · Internal Medicine · Medication Adherence and Compliance · Medicine · Nursing · Pharmaceutical Economics and Policy

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