title: Responses to Medicare drug costs among near-poor versus subsidized beneficiaries.
abstract: OBJECTIVE
  There is limited information on the protective value of Medicare Part D low-income subsidies (LIS). We compared responses to drug costs for LIS recipients with near-poor (≤200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS.
  
  
  METHODS
  Medicare Advantage beneficiaries in 2008.
  
  
  METHODS
  We examined three drug cost responses using multivariate logistic regression: cost-reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities).
  
  
  METHODS
  Telephone interviews in a stratified random sample (N = 1,201, 70 percent response rate).
  
  
  RESULTS
  After adjustment, a comparable percentage of unsubsidized near-poor (26 percent) and higher income beneficiaries reported cost-reducing behaviors (23 percent, p = .63); fewer LIS beneficiaries reported cost-reducing behaviors (15 percent, p = .019 vs near-poor). Unsubsidized near-poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent, p = .049) and LIS beneficiaries (3.1 percent, p = .027). Near-poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent, p = .050) and LIS beneficiaries (11 percent, p = .015).
  
  
  CONCLUSIONS
  Low-income subsidies provide protection from drug cost-related nonadherence and financial stress. Beneficiaries just above the LIS income threshold are most at risk for these potentially adverse behaviors.
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th floor, Suite 901, Boston, MA, 02114.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.forename: Mary
authors.initials: M
authors.lastname: Reed
authors.forename: Mary
authors.initials: M
authors.lastname: Price
authors.forename: Richard
authors.initials: R
authors.lastname: Brand
authors.forename: William H
authors.initials: WH
authors.lastname: Dow
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Newhouse
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008297:Male; D054524:Medicare Part D / Q000191:economics*; D011203:Poverty / Q000191:economics*; D014481:United States
keywords: Medicare; drug cost-sharing; low-income subsidies