title: Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D.
abstract: OBJECTIVE
  Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability.
  
  
  OBJECTIVE
  To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence.
  
  
  METHODS
  Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim.
  
  
  METHODS
  Effect of the implementation of the Medicare Part D drug benefit.
  
  
  METHODS
  The change in cost-related nonadherence and the change in cost-reduction strategies.
  
  
  RESULTS
  Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P < .001) and 2.8%, respectively (P = .001). However, reports of failure to obtain prescriptions owing to cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P < .001), purchasing outside the United States (6.9%-1.3%; P < .001), and spending less money to save for medications (8.0% to 3.5%; P < .001). Using a multivariate analysis, the main independent risk factors common to all cost-related nonadherence measures were female sex, younger age, lower income (<$30 000), self-reported visual disability, and a smaller Lawton index.
  
  
  CONCLUSIONS
  After the implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization, particularly in certain high-risk sociodemographic groups.
authors.affiliation: Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Blumberg
authors.affiliation: Columbia University Medical Center, College of Physicians and Surgeons, New York, New York.
authors.forename: Alisa J
authors.initials: AJ
authors.lastname: Prager
authors.affiliation: Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.affiliation: Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
authors.forename: George A
authors.initials: GA
authors.lastname: Cioffi
authors.affiliation: Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
authors.forename: C Gustavo
authors.initials: CG
authors.lastname: De Moraes
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics; D003258:Consumer Behavior / Q000191:economics / Q000706:statistics & numerical data*; D017046:Cost Savings / Q000191:economics*; D003430:Cross-Sectional Studies; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D005260:Female; D005901:Glaucoma / Q000188:drug therapy / Q000191:economics / Q000523:psychology*; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000191:economics*; D055118:Medication Adherence / Q000523:psychology*; D014481:United States
chemical_list: D000959:Antihypertensive Agents