title: Medication costs as a primary cause of nonadherence in the elderly.
abstract: Many elderly enrolling in the Medicare Part D prescription drug benefit, which began January 1, 2006, have low annual incomes and few countable assets. Although some are eligible for special assistance to pay for prescription medications, many others will still have significant out-of-pocket expenses while enrolled. The inability to pay for medications is an important cause of nonadherence in the elderly and has been associated with an increase in adverse drug events, acute hospitalizations, and nursing home admissions. This case describes a 77-year-old woman residing in a retirement community who was failing to respond to drug therapy for her hypertension and diabetes. The physician was unaware of her inability to pay for medications, and the patient was too embarrassed to discuss the issue. The case demonstrates some of the techniques that a pharmacist can use to adjust a patient's medication regimen to reduce the cost load, improve adherence, and maintain treatment goals.
authors.affiliation: Geriatric Pharmacotherapy Program, Virginia Commonwealth University, School of Pharmacy, Richmond, USA. lyncht@evms.edu
authors.forename: Tom
authors.initials: T
authors.lastname: Lynch
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D000069059:Atorvastatin; D003327:Coronary Disease / Q000188:drug therapy; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D011307:Drug Prescriptions / Q000191:economics*; D016568:Drugs, Generic / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006538:Heptanoic Acids / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D008687:Metformin / Q000191:economics / Q000627:therapeutic use; D008790:Metoprolol / Q000191:economics / Q000627:therapeutic use; D010349:Patient Compliance; D010595:Pharmacists; D011758:Pyrroles / Q000191:economics / Q000627:therapeutic use; D012646:Self Administration
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D016568:Drugs, Generic; D006538:Heptanoic Acids; D007004:Hypoglycemic Agents; D011758:Pyrroles; D008687:Metformin; D000069059:Atorvastatin; D008790:Metoprolol