title: Cost-related nonadherence to prescribed medication therapy among Medicare Part D beneficiaries with end-stage renal disease.
abstract: OBJECTIVE
  Medication nonadherence due to cost issues among community-dwelling patients with end-stage renal disease (ESRD) enrolled in Medicare prescription drug plans was evaluated.
  
  
  METHODS
  Demographic and health status data were collected on 1329 patients with ESRD enrolled in Medicare Part D prescription drug plans who responded to a Centers for Medicare and Medicaid Services consumer survey in early 2007. The survey data were assessed for self-reported cost-related nonadherence (CRN), defined as delaying or not filling a prescription due to cost concerns. Multivariate logistic regression analysis was performed to evaluate CRN risk relative to patient demographic characteristics, socioeconomic status, other chronic conditions, health behaviors, and access to health care services.
  
  
  RESULTS
  Overall, survey respondents with ESRD were significantly more likely than those without ESRD to report CRN in the prior six months (unadjusted odds ratio [OR], 2.34; 95% confidence interval [CI], 2.00-2.75). After controlling for potential confounding factors such as other chronic conditions, the data analysis continued to show a significant association between ESRD and an increased risk of CRN (adjusted OR, 1.23; 95% CI, 1.07-1.41). Black race and receipt of Medicare Part D Low-Income Subsidy assistance were significant independent predictors of CRN for respondents with ESRD.
  
  
  CONCLUSIONS
  In early 2007, 31% of survey respondents with ESRD enrolled in Medicare Part D drug plans reported CRN in the preceding six months. After adjusting for potential confounders, respondents with ESRD remained 23% more likely than respondents without ESRD to report CRN in the preceding six months.
authors: The Innovation Center, Centers for Medicare and Medicaid Services, Baltimore, MD, USA. diane.frankenfield@cms.hhs.gov
authors: Diane L
authors: DL
authors: Frankenfield
authors: Benjamin L
authors: BL
authors: Howell
authors: Iris I
authors: II
authors: Wei
authors: Karyn K
authors: KK
authors: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis / Q000191:economics; D003625:Data Collection; D005260:Female; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000191:economics*; D008297:Male; D054524:Medicare Part D / Q000191:economics*; D055118:Medication Adherence; D008875:Middle Aged; D055553:Prescription Drugs / Q000191:economics*; D014481:United States; D055815:Young Adult
chemical_list: D055553:Prescription Drugs