title: Pharmaceutical Cost-Saving Strategies and their Association with Medication Adherence in a Medicare Supplement Population.
abstract: BACKGROUND
  On average, Medicare Supplement insureds take about seven unique prescription medications each year, resulting in substantial out-of-pocket drug copayments, in addition to Medicare Supplement and Part D premiums. To help alleviate this financial burden, many individuals resort to cost-saving strategies that are not trackable by Part D insurance plans, likely resulting in an underestimation of medication adherence rates.
  
  
  OBJECTIVE
  We aimed to estimate utilization rates of cost-saving strategies, measure member characteristics associated with these strategies and estimate if these strategies are associated with medication adherence.
  
  
  METHODS
  This was a cross-sectional analysis of a 2012-2013 survey of AARP® Medicare Supplement plan insureds with Part D pharmaceutical coverage.
  
  
  METHODS
  The study included 5,784 community-dwelling survey respondents ≥ 65 years of age, living in ten states and with self-reported use of prescription medications.
  
  
  METHODS
  Self-reported use of cost-saving strategies included: obtaining free samples from physicians, splitting pills so medications lasted longer, purchasing medications from other countries and/or over the internet, or purchasing medications through the Veterans Administration. Propensity weighted multivariate regressions were utilized to determine characteristics associated with the use of such strategies and the association with medication adherence as measured from Medicare Part D claims.
  
  
  RESULTS
  Among those taking medications, 39.6% used cost-saving strategies. Those using these strategies were significantly (p < 0.05) more likely to be male, non-minority, have more comorbid conditions, have more disabilities and use more medications. Few variables were significantly related to pharmaceutical nonadherence, but those who were nonadherent were significantly more likely to use more medications, split pills, obtain free samples from their physicians and be male.
  
  
  CONCLUSIONS
  Cost-saving strategies are used extensively as a means to augment Medicare Part D coverage. These strategies are associated with measured medication nonadherence and likely result in underreporting of medication adherence rates. Pharmacy management programs should consider these additional medication sources in assisting plan members to problem solve cost-related medication management issues.
authors: Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI, 48108, USA, shirley.musich@optum.com.
authors: Shirley
authors: S
authors: Musich
authors: Yan
authors: Y
authors: Cheng
authors: Shaohung S
authors: SS
authors: Wang
authors: Cynthia E
authors: CE
authors: Hommer
authors: Kevin
authors: K
authors: Hawkins
authors: Charlotte S
authors: CS
authors: Yeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D016345:Medicare Part B; D055118:Medication Adherence; D055553:Prescription Drugs / Q000008:administration & dosage / Q000191:economics*; D011306:Prescription Fees; D014481:United States
chemical_list: D055553:Prescription Drugs