title: Seniors with chronic health conditions and prescription drugs: benefits, wealth, and health.
abstract: OBJECTIVE
  The objectives of this study were to examine the relationship between prescription benefit status and access to medications among Medicare beneficiaries with hypertension, congestive heart failure, coronary artery disease, and diabetes and to determine how income, wealth, and health status influence this relationship.
  
  
  METHODS
  We analyzed survey and administrative data for 4492 Medicare + Choice enrollees aged 67 and above enrolled in a predominantly group-model health maintenance organization in 2000. Outcome measures included difficulty affording medications, methods of coping with medication costs including obtaining medicines from another country, using free samples, and stretching out medications to make them last longer. Independent variables included prescription benefit status, income, wealth measures, health status, and out-of-pocket prescription drug spending.
  
  
  RESULTS
  Lacking a prescription benefit was independently associated with difficulty affording medications (25% of those without a benefit vs. 17% with a benefit) and coping methods such as stretching out medications. Lower income, lower assets, and worse health status also independently predicted greater difficulty as measured by these outcomes; there was no effect modification between these factors and benefit status. Relative to national figures, out-of-pocket spending in this setting was quite low, with only 0.2 and 13% of those with and without a benefit, respectively, spending over 100 dollars per month. Higher out-of-pocket spending predicted greater difficulty affording medications but not stretching out medications.
  
  
  CONCLUSIONS
  Efforts to improve medication accessibility for older Americans with chronic conditions need to address not only insurance coverage but also barriers related to socioeconomic status and health status.
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, WA 98195-4696, USA. saver@u.washington.edu
authors.forename: Barry G
authors.initials: BG
authors.lastname: Saver
authors.forename: Mark P
authors.initials: MP
authors.lastname: Doescher
authors.forename: J Elizabeth
authors.initials: JE
authors.lastname: Jackson
authors.forename: Paul
authors.initials: P
authors.lastname: Fishman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy*; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics*; D017850:Economics, Pharmaceutical; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D020398:Medicare Part C; D012923:Social Class; D014481:United States