Self-Restriction of Medications Due to Cost in Seniors Without Prescription Coverage

Division of Geriatrics, San Francisco VA Medical Center, University of California-San Francisco 94121, USA.
Journal of General Internal Medicine (Impact Factor: 3.45). 12/2001; 16(12):793-9. DOI: 10.1046/j.1525-1497.2001.10412.x
Source: PubMed


Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk.
Cross-sectional study from the 1995-1996 wave of the Survey of Asset and Health Dynamics Among the Oldest Old, a population-based survey of Americans age 70 years and older.
Subjects were asked the extent of their prescription coverage, and whether they had taken less medicine than prescribed for them because of cost over the prior 2 years. We used bivariate and multivariate analyses to identify risk factors for medication restriction in subjects who lacked prescription coverage. Among these high-risk groups, we then examined the effect of prescription coverage on rates of medication restriction.
Of 4,896 seniors who regularly used prescription medications, medication restriction because of cost was reported by 8% of subjects with no prescription coverage, 3% with partial coverage, and 2% with full coverage (P <.01 for trend). Among subjects with no prescription coverage, the strongest independent predictors of medication restriction were minority ethnicity (odds ratio [OR], 2.9 compared with white ethnicity; 95% confidence interval [95% CI], 2.0 to 4.2), annual income <$10,000 (OR, 3.8 compared with income > or =$20,000; 95% CI, 2.4 to 6.1), and out-of-pocket prescription drug costs >$100 per month (OR, 3.3 compared to costs < or =$20; 95% CI, 1.5 to 7.2). The prevalence of medication restriction in members of these 3 risk groups was 21%, 16%, and 13%, respectively. Almost half (43%) of subjects with all 3 risk factors and no prescription coverage reported restricting their use of medications. After multivariable adjustment, high-risk subjects with no coverage had 3 to 15 times higher odds of medication restriction than subjects with partial or full coverage (P <.01).
Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications.

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    • "Some of these studies suggest that relatively small increases in copayments may lead to clinically significant reductions in prescription utilization, and that these decreases may occur not only for non-essential treatments but also for essential medications such as insulin, thiazides and furosemide [15]. Patients with low incomes, multiple chronic health problems or no prescription drug coverage may be particularly susceptible to such “cost-related non-adherence” [16], although there are a number of other factors that mediate these associations as well [17]. Despite the insights from these studies, they focus on a specific policy change among a selected population, rather than a general deterioration in the economic climate such as has accompanied the recent economic recession. "
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    Full-text · Article · Nov 2012 · BMC Health Services Research
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    • "The economic burden of healthcare impacts the individual’s access to medications and their chronic condition.4,5,6,7,8,9 Studies have shown that patients with limited access to prescription drugs due to reduced insurance coverage demonstrate significantly decreased compliance and increased morbidity.10,11,12 One intent of Medicare Part D was to increase access to outpatient prescription drugs for the elderly by reducing cost-related barriers. "
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    ABSTRACT: Objectives To assess patients’ 1) satisfaction with their decision to enroll or not enroll in the Medicare Part D program, and 2) clinical status of diabetes before and after decision to enroll in Medicare Part D. Methods Patients 65 years or older were enrolled in the study from November 2006 through February 2007. Patients were screened by a clinical pharmacist at their clinician visit and administered a Medicare Part D satisfaction survey. Upon completion of the survey, a retrospective chart review was completed in diabetic patients who were enrolled in Medicare Part D to assess goal attainment of glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL) and blood pressure. Pre-enrollment values were obtained in the 6 months prior to the start of Medicare Part D enrollment (July 1- December 31, 2005). Post- enrollment values were obtained after enrollment was complete for the 2006 year (May 1- October 31, 2006). Results Results show that 74% (60/81) of patients surveyed were enrolled into the Medicare Part D program, including patients who have dual eligibility. Of the 60 patients who were enrolled in Medicare Part D, 48 patients (80.0%) responded that they were satisfied with their decision to enroll. Clinical outcomes were unchanged from the pre-enrollment to the post-enrollment periods. Mean HbA1c was 7.47% in the pre-enrollment period and 7.25% post- enrollment (differencepre-post = 0.23; 95%CI = -0.28 to 0.73). There was no change in LDL in the two time periods (pre = 79.4 mg/dL; post = 79.7; differencepre-post = -0.25; 95%CI = -13.6 to 13.1). Similarly, there were no significant differences observed for blood pressure. Mean systolic blood pressure was 129.5 in the pre-enrollment period and 131.6 in the post-enrollment period (differencepre-post = -2.1; 95%CI = -7.0 to 2.7). Mean diastolic blood pressure was 70.3 for the pre- enrollment period and 70.7 for the post-enrollment period (differencepre-post = -0.4; 95%CI = -4.2 to 3.4). Conclusion Patients were generally satisfied with their decision to enroll in Medicare Part D. Clinical outcomes were not affected by participation in a Medicare Part D plan. More longitudinal studies are necessary to determine long term impact of Medicare Part D on diabetes management.
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