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Medication Adherence and Medicare’s Part D Prescription Drug Program

October 29, 2009
11:12 am

Below is my blog post which was featured today on Disruptive Women In Health Care:

If only it were an urban legend that senior citizens in the United States were cutting their physician-prescribed pills in half or ignoring their medications altogether in order to have enough money for food and utilities, but one doesn’t need academic studies to know that this kind of economically-forced non-adherence has too often been the case in our country.

After Congress passed the Medicare Modernization Act (MMA), creating the Part D prescription drug program, the Healthcare Leadership Council – an advocacy group comprised of chief executives of healthcare companies and organizations from all health sectors – literally took its show on the road.  Having worked for passage of the MMA, we felt a responsibility to ensure that the new Part D program was implemented successfully and that seniors knew how to take advantage of the new benefit.

In community meetings across the country, I met with scores of elderly men and women who told me heart-wrenching stories of the hard choices they had to make between medications and other necessities, knowing they were putting their health at risk.

Has the Medicare Part D prescription drug program made a difference in drug adherence within this vulnerable population?  The results are quite positive but they also show that further improvements remain necessary.

The impact of Part D on drug adherence among the elderly is unquestionable.  A survey in April of this year by KRC Research (commissioned by Medicare Today, a coalition of local and national organizations we founded to provide reliable Part D information to seniors) found that three of every 10 Medicare beneficiaries reported that they are now taking medications that they had previously either skipped or rationed.

A more recent study published this week in the Journal of the American Medical Association, involving data collected over a three-year period from over 24,000 Medicare beneficiaries, found that 11.5 percent of beneficiaries skipped medications in 2006, after the drug benefit was introduced, compared to 14.1 percent in 2005.  The study also found that 7.6% reported cutting back on spending for basic needs in 2006 to afford medications, compared to 11.1% doing so the previous year, before they had prescription drug coverage.

That’s significant progress, coming in just the first year of Part D implementation.

The JAMA study also showed, however, that the sickest beneficiaries, those requiring the most prescriptions, showed no improvement in their drug adherence.  That data underscores the need for further improvement in the Part D program.

It can be presumed that many of those high drug spenders fall into the so-called “donut hole”, the spending gap within which Part D doesn’t cover prescription costs.  Health reform bills working their way through Congress right now include provisions to cut in half those “donut hole” out-of-pocket costs.  This would be a welcome change and one that presumably would strengthen drug adherence among less-healthy Medicare beneficiaries.

Focus needs to be given, as well, to the approximately two million Medicare beneficiaries who are eligible for low-income subsidies but are not enrolled in the prescription drug benefit program.  Not only is intense community outreach necessary to help enroll these beneficiaries, but Congress should also take a look at the asset tests that may be keeping many economically-vulnerable seniors from the benefits they need.

We’re moving closer to the day in which economics ceases to be a barrier to drug adherence among the elderly, but there is still work to be done.

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