title: Patient-provider communication regarding drug costs in Medicare Part D beneficiaries with diabetes: a TRIAD Study.
abstract: BACKGROUND
  Little is known about drug cost communications of Medicare Part D beneficiaries with chronic conditions such as diabetes. The purpose of this study is to assess Medicare Part D beneficiaries with diabetes' levels of communication with physicians regarding prescription drug costs; the perceived importance of these communications; levels of prescription drug switching due to cost; and self-reported cost-related medication non-adherence.
  
  
  METHODS
  Data were obtained from a cross-sectional survey (58% response rate) of 1,458 Medicare beneficiaries with diabetes who entered the coverage gap in 2006; adjusted percentages of patients with communication issues were obtained from multivariate regression analyses adjusting for patient demographics and clinical characteristics.
  
  
  RESULTS
  Fewer than half of patients reported discussing the cost of medications with their physicians, while over 75% reported that such communications were important. Forty-eight percent reported their physician had switched to a less expensive medication due to costs. Minorities, females, and older adults had significantly lower levels of communication with their physicians regarding drug costs than white, male, and younger patients respectively. Patients with < $25 K annual household income were more likely than higher income patients to have talked about prescription drug costs with doctors, and to report cost-related non-adherence (27% vs. 17%, p < .001).
  
  
  CONCLUSIONS
  Medicare Part D beneficiaries with diabetes who entered the coverage gap have low levels of communication with physicians about drug costs, despite the high perceived importance of such communication. Understanding patient and plan-level characteristics differences in communication and use of cost-cutting strategies can inform interventions to help patients manage prescription drug costs.
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, CA, USA. Julie.A.Schmittdiel@kp.org
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Neil
authors.initials: N
authors.lastname: Steers
authors.forename: O Kenrik
authors.initials: OK
authors.lastname: Duru
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.forename: Elaine
authors.initials: E
authors.lastname: Quiter
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Tseng
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D016527:Drug Costs; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D; D010817:Physician-Patient Relations; D014481:United States