An article published in JAMA reports that after the implementation of Medicare Part D, cost-related medication nonadherence may have improved overall.
In 2003 Congress passed the Medicare Prescription Drug Improvement and Modernization Act to help the millions of elderly and disabled Americans who had insufficient or no insurance coverage for outpatient medications. “In the face of these economic barriers, several large surveys in the United States have shown that older individuals have resorted to behaviors such as skipping doses, reducing doses, and letting prescriptions go unfilled. Such cost-related medication nonadherence (CRN) is associated with increased risk of myocardial infarction, stroke, and preventable hospitalization,” write researcher Jeanne M. Madden, Ph.D. (Harvard Medical School and Harvard Pilgrim Health Care, Boston) and colleagues. Beneficiaries of Medicare, since January 2006, have had the option to purchase Part D, providing prescription drugs benefits that are subsidized by Medicare and obtainable through private health plans. There is no evidence, however, indicating how Medicare Part D has impacted CRN.
Madden and colleagues set out to evaluate how the implementation of Part D changed CRN behavior and spending patterns of beneficiaries (i.e., the substitution of medicines for basic needs such as food). The sample studied included 24,234 nationally representative, community-dwelling Medicare enrollees who responded to the Medicare Current Beneficiary Survey (MCBS) in 2004, 2005, and 2006. There was a 72.3% response rate.
The investigators found that the unweighted decrease in CRN was larger from 2005 to 2006 (14.1% to 11.5%, respectively), after the implementation of Medicare Part D, than from 2004 to 2005 (15.2% to 14.1%, respectively). They did not, however, find statistically significant changes in CRN among beneficiaries characterized as having fair-to-poor health, even though 22.2% of this group exhibited CRN in 2005 and significant decreases were noted among beneficiaries characterized as having good-to-excellent health.
The authors write that, “Overall, our findings suggest that that the intensive medicine needs and financial barriers to access among the sickest beneficiaries may not have been fully addressed by Part D.”
Using regression analysis to control for changes from 2004 to 2005, the researchers found modest and significant reductions in CRN among relatively poorer beneficiaries but not for relatively richer ones. In addition, an analysis of spending patterns showed that beneficiaries with fair-to-poor health and good-to-excellent health significantly reduced their prevalence of substituting medicines for basic needs.
“In conclusion, we found small but significant population-level decreases in CRN and spending less on basic needs to afford medicines, nearly a year after an unprecedented shift in Medicare policy-the implementation of the Part D drug benefit. Those beneficiaries in poor health or with multiple morbidities who had substantially higher baseline CRN did not experience decreases in CRN associated with Part D implementation, although they did report reductions in spending less on basic needs. Further research is needed to determine which specific aspects of Part D did or did not alleviate the persistent burden of medication costs. Part D claims data, linked to detailed Part D plan characteristics, must be made available to study the impact of the new Medicare drug benefit on actual utilization of medications and health outcomes,” conclude the authors.
Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D
Jeanne M. Madden; Amy J. Graves; Fang Zhang; Alyce S. Adams; Becky A. Briesacher; Dennis Ross-Degnan; Jerry H. Gurwitz; Marsha Pierre-Jacques; Dana Gelb Safran; Gerald S. Adler; Stephen B. Soumerai
JAMA. 2008;299(16):1922-1928.
Written by: Peter M Crosta