title: The Medicare drug benefit (Part D) and treatment of heart failure in older adults.
abstract: BACKGROUND
  Adherence to pharmacotherapy for heart failure is poor among older adults in part because of high prescription drug costs. We examined the impact of improvements in drug coverage under Medicare Part D on utilization of, and adherence to, medications for heart failure in older adults.
  
  
  METHODS
  We used a quasi-experimental approach to analyze pharmacy claims for 6,950 individuals aged >or=65 years with heart failure enrolled in a Medicare managed care organization 2 years before and after Part D's implementation. We compared prescription fill patterns among individuals who moved from limited (quarterly benefits caps of USD 150 or USD 350) or no drug coverage to Part D in 2006 with those who had generous employer-sponsored coverage throughout the study period.
  
  
  RESULTS
  Individuals who previously lacked drug coverage filled approximately 6 more heart failure prescriptions annually after Part D (adjusted ratio of prescription counts = 1.36, 95% CI 1.29-1.44, P < .0001 relative to the comparison group). Those previously lacking drug coverage were more likely to fill prescriptions for an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker plus a beta-blocker after Part D (adjusted ratio of odds ratios = 1.73, 95% CI 1.42-2.10, P < .0001) and more likely to be adherent to such pharmacotherapy (adjusted ratio of odds ratios = 2.95, 95% CI 1.85-4.69, P < .0001) relative to the comparison group.
  
  
  CONCLUSIONS
  Medicare Part D was associated with improved access to medications and adherence to pharmacotherapy in older adults with heart failure.
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. jdonohue@pitt.edu
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.forename: Yuting
authors.initials: Y
authors.lastname: Zhang
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.forename: Aiju
authors.initials: A
authors.lastname: Men
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs / Q000639:trends*; D005252:Fees, Pharmaceutical / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D010349:Patient Compliance; D055553:Prescription Drugs / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
chemical_list: D002317:Cardiovascular Agents; D055553:Prescription Drugs