title: Cost-related nonadherence in the Medicare program: the impact of Part D.
abstract: BACKGROUND
  Cost-related nonadherence (CRN) among Medicare beneficiaries declined after the implementation of the Part D program, but it is unknown whether CRN changes varied on the basis of beneficiaries' change in drug coverage.
  
  
  OBJECTIVE
  To determine how CRN changed with the introduction of Part D, and whether CRN changes from 2005 to 2006 varied between newly insured beneficiaries, continuously insured beneficiaries, and continuously uninsured beneficiaries.
  
  
  METHODS
  CRN, drug coverage, and beneficiary characteristics in 2005 and 2006 were constructed from merged Medicare Current Beneficiary Survey Access to Care files (sample, n=8935). Change in CRN was modeled using multinomial logistic regression to identify predictors of resolved CRN (reported in 2005 but not in 2006), unresolved CRN (reported in 2005 and 2006), and new CRN (reported in 2006 but not in 2005), relative to no CRN (not reported in 2005 or 2006).
  
  
  RESULTS
  Rates of CRN declined from 2005 to 2006 for all beneficiaries, with the greatest reductions (from 22.1% in 2005 to 14.3% in 2006) for newly insured beneficiaries who gained drug coverage through Part D. In adjusted analyses, newly insured beneficiaries were more likely to have resolved CRN (adjusted odds ratio [AOR] =1.7; 95% confidence interval, 1.3-2.2). Younger beneficiaries (under the age of 65 years) and beneficiaries with multiple chronic conditions, poor health, and depression were significantly more likely to report CRN.
  
  
  CONCLUSIONS
  Part D coverage reduced but did not eliminate CRN for newly insured beneficiaries. Unresolved CRN persisted for newly insured and continuously uninsured beneficiaries, particularly among disabled beneficiaries.
authors: Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA 99210-1495, USA. jjkennedy@wsu.edu
authors: James J
authors: JJ
authors: Kennedy
authors: Matthew
authors: M
authors: Maciejewski
authors: Darren
authors: D
authors: Liu
authors: Elizabeth
authors: E
authors: Blodgett
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D054524:Medicare Part D / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D055553:Prescription Drugs / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs