title: Functional Limitations, Medication Support, and Responses to Drug Costs among Medicare Beneficiaries.
abstract: OBJECTIVE
  Standard Medicare Part D prescription drug benefits include substantial and complex cost-sharing. Many beneficiaries also have functional limitations that could affect self-care capabilities, including managing medications, but also have varying levels of social support to help with these activities. We examined the associations between drug cost responses, functional limitations, and social support.
  
  
  METHODS
  We conducted telephone interviews in a stratified random sample of community-dwelling Medicare Advantage beneficiaries (N = 1,201, response rate = 70.0%). Participants reported their functional status (i.e., difficulty with activities of daily living) and social support (i.e., receiving help with medications). Drug cost responses included cost-reducing behaviors, cost-related non-adherence, and financial stress.
  
  
  METHODS
  We used multivariate logistic regression to assess associations among functional status, help with medications, and drug cost responses, adjusting for patient characteristics.
  
  
  RESULTS
  Respondents with multiple limitations who did not receive help with their medications were more likely to report cost-related non-adherence (OR = 3.2, 95% CI: 1.2-8.5) and financial stress (OR = 2.4, 95% CI: 1.3-4.5) compared to subjects with fewer limitations and no help; however, those with multiple limitations and with medication help had similar odds of unfavorable cost responses as those with fewer limitations.
  
  
  CONCLUSIONS
  The majority of beneficiaries with functional limitations did not receive help with medications. Support with medication management for beneficiaries who have functional limitations could improve adherence and outcomes.
authors.affiliation: School of Public Health, U.C. Berkeley, University of California, Berkeley, CA, United States of America.|Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America.
authors.forename: Christopher
authors.initials: C
authors.lastname: Whaley
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America.
authors.forename: Mary
authors.initials: M
authors.lastname: Reed
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States of America.|Department of Medicine Harvard Medical School, Boston, MA, United States of America.|Department of Health Care Policy, Department of Health Care Policy, Boston, MA, United States of America.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States of America.|Department of Medicine Harvard Medical School, Boston, MA, United States of America.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D018803:Models, Economic; D055553:Prescription Drugs / Q000191:economics*; D014481:United States
chemical_list: D055553:Prescription Drugs