Responses to Medicare Drug Costs among Near‐Poor versus Subsidized Beneficiaries. (13th May 2013)

• Record Type: Journal Article
• Authors: Fung, Vicki; Reed, Mary; Price, Mary; Brand, Richard; Dow, William H.; Newhouse, Joseph P.; Hsu, John
• Is Part Of: Health services research. Volume 48:Number 5(2013:Oct.)
• Page Start: 1653
• Page End: 1668
• Publication Date: 2013-05-13
• Subjects: Medicare -- low‐income subsidies -- drug cost‐sharing; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12062
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract : Objective: There is limited information on the protective value of Medicare Part D low‐income subsidies (LIS). We compared responses to drug costs for LIS recipients with near‐poor (≤200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS. Data Sources/Study Setting: Medicare Advantage beneficiaries in 2008. Study Design: We examined three drug cost responses using multivariate logistic regression: cost‐reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities). Data Collection: Telephone interviews in a stratified random sample ( N = 1, 201, 70 percent response rate). Principal Findings: After adjustment, a comparable percentage of unsubsidized near‐poor (26 percent) and higher income beneficiaries reported cost‐reducing behaviors (23 percent, p = .63); fewer LIS beneficiaries reported cost‐reducing behaviors (15 percent, p = .019 vs near‐poor). Unsubsidized near‐poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent, p = .049) and LIS beneficiaries (3.1 percent, p = .027). Near‐poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent, p = .050) and LIS beneficiaries (11 percent, p = .015). Conclusions: Low‐income subsidies provide protection from drug cost‐related nonadherence and financial stress. Beneficiaries just above the LIS income threshold are most at risk for these potentially adverse behaviors.