title: Medication affordability gains following Medicare Part D are eroding among elderly with multiple chronic conditions.
abstract: Elderly Americans, especially those with multiple chronic conditions, face difficulties paying for prescriptions, which results in worse adherence to and discontinuation of therapy, called cost-related medication nonadherence. Medicare Part D, implemented in January 2006, was supposed to address issues of affordability for prescriptions. We investigated whether the gains in medication affordability attributable to Part D persisted during the six years that followed its implementation. Overall, we found continued incremental improvements in medication affordability in the period 2007-09 that eroded during the period 2009-11. Among elderly beneficiaries with four or more chronic conditions, we observed an increase in the prevalence of cost-related nonadherence from 14.4 percent in 2009 to 17.0 percent in 2011, reversing previous downward trends. Similarly, the prevalence among the sickest elderly of forgoing basic needs to purchase medicines decreased from 8.7 percent in 2007 to 6.8 percent in 2009 but rose to 10.2 percent in 2011. Our findings highlight the need for targeted policy efforts to alleviate the persistent burden of drug treatment costs on this vulnerable population.
authors.affiliation: Huseyin Naci is a fellow in pharmaceutical policy research, Department of Population Medicine, Harvard Medical School, in Boston, Massachusetts, and a research fellow at the London School of Economics and Political Science, in the United Kingdom.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Naci
authors.affiliation: Stephen B. Soumerai is a professor in the Department of Population Medicine and director of the Drug Policy Research Group, Harvard Medical School and Harvard Pilgrim Health Care Institute, both in Boston.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.affiliation: Dennis Ross-Degnan is an associate professor in the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.affiliation: Fang Zhang is an assistant professor in the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Becky A. Briesacher is an associate professor at the University of Massachusetts Medical School, in Worcester.
authors.forename: Becky A
authors.initials: BA
authors.lastname: Briesacher
authors.affiliation: Jerry H. Gurwitz is a professor at the University of Massachusetts Medical School and executive director of the Meyers Primary Care Institute, in Worcester.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Jeanne M. Madden (jeanne_madden@hphc.org) is an instructor in the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Madden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy*; D057172:Economic Recession; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000191:economics*; D011306:Prescription Fees; D015995:Prevalence; D011795:Surveys and Questionnaires; D014481:United States; D016903:Drug Monitoring
keywords: Cost of Health Care; Medicare
references.citation: N Engl J Med. 1994 Sep 8;331(10):650-5
references.pmid: 8052275
references.citation: N Engl J Med. 1991 Oct 10;325(15):1072-7
references.pmid: 1891009
references.citation: N Engl J Med. 2009 Jul 23;361(4):406-14
references.pmid: 19625722
references.citation: Health Aff (Millwood). 2002 Jul-Dec;Suppl Web Exclusives:W253-68
references.pmid: 12703581
references.citation: J Gen Intern Med. 2007 Jun;22(6):864-71
references.pmid: 17410403
references.citation: Health Aff (Millwood). 2010 Mar-Apr;29(3):522-9
references.pmid: 20133357
references.citation: J Cancer Surviv. 2011 Dec;5(4):395-404
references.pmid: 21800053
references.citation: JAMA. 2008 Apr 23;299(16):1922-8
references.pmid: 18430911
references.citation: JAMA. 2007 Jul 4;298(1):61-9
references.pmid: 17609491
references.citation: Arch Gen Psychiatry. 2007 May;64(5):602-8
references.pmid: 17485612
references.citation: Health Serv Res. 2005 Aug;40(4):1234-46
references.pmid: 16033502
references.citation: Medicare Medicaid Res Rev. 2012 Feb 08;2(1):
references.pmid: 24800135
references.citation: J Am Geriatr Soc. 2010 Sep;58(9):1764-79
references.pmid: 20863336
references.citation: JAMA. 2009 Oct 28;302(16):1755-6
references.pmid: 19861666
references.citation: Med Care. 2010 Jun;48(6):503-9
references.pmid: 20473197
references.citation: Arch Intern Med. 2005 Mar 28;165(6):633-6
references.pmid: 15795338
references.citation: Health Aff (Millwood). 2012 Oct;31(10):2259-65
references.pmid: 23048107
references.citation: Arch Intern Med. 2006 Sep 25;166(17):1829-35
references.pmid: 17000938
references.citation: Am J Public Health. 2011 Dec;101(12):2293-8
references.pmid: 22021301
references.citation: J Rheumatol. 2013 Feb;40(2):137-43
references.pmid: 23322458
references.citation: Med Care. 2011 Sep;49(9):834-41
references.pmid: 21544002
references.citation: N Engl J Med. 2012 Aug 16;367(7):590-3
references.pmid: 22873429
references.citation: Health Aff (Millwood). 2005 Jan-Jun;Suppl Web Exclusives:W5-152-W5-166
references.pmid: 15840625
references.citation: J Gen Intern Med. 2007 Dec;22 Suppl 3:391-5
references.pmid: 18026807
references.citation: Am J Geriatr Psychiatry. 2009 Dec;17(12):1068-76
references.pmid: 20104063
references.citation: Med Care. 2008 Apr;46(4):444-8
references.pmid: 18362826
references.citation: Med Care. 2004 Jul;42(7):626-34
references.pmid: 15213486