Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D

Context Cost- related medication nonadherence ( CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare prescription drug coverage ( Part D) on CRN is unknown. Objective To estimate changes in CRN and forgoing basic needs to pay for drugs following Part D implementation. Design, Setting, and Participants In a population- level study design, changes in study outcomes between 2005 and 2006 before and after Medicare Part D implementation were compared with historical changes between 2004 and 2005. The community-dwelling sample of the nationally representative Medicare Current Beneficiary Survey ( unweighted unique n= 24 234; response rate, 72.3%) was used, and logistic regression analyses were controlled for demographic characteristics, health status, and historical trends. Main Outcome Measures Self- reports of CRN ( skipping or reducing doses, not obtaining prescriptions) and spending less on basic needs to afford medicines. Results The unadjusted, weighted prevalence of CRN was 15.2% in 2004, 14.1% in 2005, and 11.5% after Part D implementation in 2006. The prevalence of spending less on basic needs was 10.6% in 2004, 11.1% in 2005, and 7.6% in 2006. Adjusted analyses comparing 2006 with 2005 and controlling for historical changes ( 2005 vs 2004) demonstrated significant decreases in the odds of CRN ( ratio of odds ratios [ ORs], 0.85; 95% confidence interval [ CI], 0.74- 0.98; P=. 03) and spending less on basic needs ( ratio of ORs, 0.59; 95% CI, 0.48- 0.72; P <. 001). No significant changes in CRN were observed among beneficiaries with fair to poor health ( ratio of ORs, 1.00; 95% CI, 0.82- 1.21; P=. 97), despite high baseline CRN prevalence for this group ( 22.2% in 2005) and significant decreases among beneficiaries with good to excellent health ( ratio of ORs, 0.77; 95% CI, 0.63- 0.95; P=. 02). However, significant reductions in spending less on basic needs were observed in both groups ( fair to poor health: ratio of ORs, 0.60; 95% CI, 0.47- 0.75; P <. 001; and good to excellent health: ratio of ORs, 0.57; 95% CI, 0.44- 0.75; P <. 001). Conclusions In this survey population, there was evidence for a small but significant overall decrease in CRN and forgoing basic needs following Part D implementation. However, no net decrease in CRN after Part D was observed among the sickest beneficiaries, who continued to experience higher rates of CRN.