Responses to Medicare drug costs among near-poor versus subsidized beneficiaries.

OBJECTIVE There is limited information on the protective value of Medicare Part D low-income subsidies (LIS). We compared responses to drug costs for LIS recipients with near-poor (≤200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS. DATA SOURCES/STUDY SETTING Medicare Advantage beneficiaries in 2008. STUDY DESIGN We examined three drug cost responses using multivariate logistic regression: cost-reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities). DATA COLLECTION Telephone interviews in a stratified random sample (N = 1,201, 70 percent response rate). PRINCIPAL FINDINGS After adjustment, a comparable percentage of unsubsidized near-poor (26 percent) and higher income beneficiaries reported cost-reducing behaviors (23 percent, p = .63); fewer LIS beneficiaries reported cost-reducing behaviors (15 percent, p = .019 vs near-poor). Unsubsidized near-poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent, p = .049) and LIS beneficiaries (3.1 percent, p = .027). Near-poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent, p = .050) and LIS beneficiaries (11 percent, p = .015). CONCLUSIONS Low-income subsidies provide protection from drug cost-related nonadherence and financial stress. Beneficiaries just above the LIS income threshold are most at risk for these potentially adverse behaviors.

[1]  C. Mangione,et al.  Falling into the coverage gap: Part D drug costs and adherence for Medicare Advantage prescription drug plan beneficiaries with diabetes. , 2010, Health services research.

[2]  Using Matched Survey and Administrative Data to Estimate Eligibility for the Medicare Part D Low-Income Subsidy Program , 2010, Social security bulletin.

[3]  A. Basu,et al.  The Impact of Medicare Part D on Medicare-Medicaid Dual-Eligible Beneficiaries' Prescription Utilization and Expenditures , 2008, Health services research.

[4]  S. Zuvekas,et al.  Dual eligibles with mental disorders and Medicare part D: how are they faring? , 2009, Health affairs.

[5]  J. Lave,et al.  The effects of the coverage gap on drug spending: a closer look at Medicare Part D. , 2009, Health affairs.

[6]  S. Schneeweiss,et al.  The Effect of Transitioning to Medicare Part D Drug Coverage in Seniors Dually Eligible for Medicare and Medicaid , 2008, Journal of the American Geriatrics Society.

[7]  H. Cannon.  MedPAC Releases March 2008 Report to the Congress: Medicare Payment Policy , 2008 .

[8]  A. Fendrick,et al.  Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in Health Care , 2008, Journal of General Internal Medicine.

[9]  J. Newhouse,et al.  Medicare beneficiaries' knowledge of Part D prescription drug program benefits and responses to drug costs. , 2008, JAMA.

[10]  T. Cheetham,et al.  Successful conversion of patients with hypercholesterolemia from a brand name to a generic cholesterol-lowering drug. , 2005, The American journal of managed care.

[11]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[12]  N. Krieger.  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. , 1992, American journal of public health.

[13]  D. Campbell,et al.  Regression-Discontinuity Analysis: An Alternative to the Ex-Post Facto Experiment , 1960 .