Patterns of prescription drug expenditures and medication adherence among medicare part D beneficiaries with and without the low-income supplement

• Published in: BMC health services research 2014-12, Vol.14 (1), p.665-665, Article 665
• Main Authors: Yala, Stella M, Duru, Obidiugwu Kenrik, Ettner, Susan L, Turk, Norman, Mangione, Carol M, Brown, Arleen F
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis; Antihypertensives; Arthritis; Beneficiaries; Cardiovascular disease; Censuses; Cost control; Cross-Sectional Studies; Diabetes; Diabetes Mellitus - drug therapy; Drug stores; Economic aspects; Expenditures; Female; Financing, Personal - economics; Forecasts and trends; Geffen, David; Generalized linear models; Government subsidies; Health aspects; Health Expenditures; Humans; Hypertension; Insurance coverage; Insurance Coverage - economics; Low income groups; Male; Medicaid; Medical care, Cost of; Medicare; Medicare Part D - economics; Medicare Prescription Drug Improvement & Modernization Act 2003-US; Medication Adherence; Medicine; Older people; Patient compliance; Pharmacy; Poverty; Prescription drugs; Prescription Drugs - economics; Retrospective Studies; United States; Variables
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-014-0665-3

The association between the Medicare Part D low-income subsidy (LIS), gap coverage, and outcomes such as medical expenditures, prescription fills, and medication adherence is not well understood. The purpose of this study was to examine the relationship between the LIS and these measures for patients within a large, national Part D plan in the United States. In this cross-sectional, retrospective analysis, we compared total and plan expenditures, out-of-pocket costs, and medication fills and adherence for three categories of Medicare beneficiaries: non-LIS beneficiaries without gap coverage (non-LIS/non-GC), non-LIS beneficiaries with gap coverage (non-LIS/GC), and LIS beneficiaries (LIS). LIS beneficiaries, relative to non-LIS/non-GC and non-LIS/GC beneficiaries, had higher total expenditures ($1,887 vs. $1,360 vs. $1,341); lower out-of-pocket costs ($148 vs. $546 vs. $570); more expenditures exceeding the gap threshold (27.6% vs. 18.4% vs. 16.9%); and slightly higher adherence to blood pressure (65.6% vs. 64.2% vs. 62.4%); diabetes (62.5% vs. 57.7 vs. 57.4%); and lipid-lowering (59.6% vs. 57.0 vs. 55.6%) medications. LIS beneficiaries had higher total expenditures, lower out-of-pocket costs, and modestly better adherence to diabetes medications than non-LIS/non-GC and non-LIS/GC beneficiaries.