title: Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011.
abstract: BACKGROUND
  Disabled Americans who qualify for Medicare coverage typically have multiple chronic conditions, are highly dependent on effective drug therapy, and have limited financial resources, putting them at risk for cost-related medication nonadherence (CRN). Since 2006, the Part D benefit has helped Medicare beneficiaries afford medications.
  
  
  OBJECTIVE
  To investigate recent national trends in medication affordability among this vulnerable population, stratified by morbidity burden.
  
  
  METHODS
  We estimated annual rates of medication affordability among nonelderly disabled participants in a nationally representative survey (2006-2011, n=14,091 person-years) using multivariate logistic regression analyses.
  
  
  METHODS
  Survey-reported CRN and spending less on other basic needs to afford medicines.
  
  
  RESULTS
  In the 6 years following Part D implementation, the proportion of disabled Medicare beneficiaries reporting CRN ranged from 31.6% to 35.6%, while the reported prevalence of spending less on other basic needs to afford medicines ranged from 17.7% to 21.8%. Across study years, those with multiple chronic conditions had consistently worse affordability problems. In 2011, the prevalence of CRN was 37.3% among disabled beneficiaries with ≥ 3 morbidities as compared with 28.1% among those with fewer morbidities; for spending less on basic needs, the prevalence was 25.4% versus 15.7%, respectively. There were no statistically detectable changes in either measure when comparing 2011 with 2007.
  
  
  CONCLUSIONS
  Disabled Medicare beneficiaries continue to struggle to afford prescription medications. There is an urgent need for focused policy attention on this vulnerable population, which has inadequate financial access to drug treatments, despite having drug coverage under Medicare Part D.
authors.affiliation: *Drug Policy Research Group, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston †Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Naci
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Becky A
authors.initials: BA
authors.lastname: Briesacher
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Madden
mesh_terms: D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring