Plenary III–04: Responses to Drug Costs: Year Three of the Medicare Part D Program

Abstract

Background/Aims: Many Medicare Part D beneficiaries face substantial prescription drug cost-sharing. In the first year of the program, many beneficiaries reported substantial drug use changes in response to the coverage gap. In response, an increasing number of plans offer generic drug coverage during the gap. We compared responses to Part D costs among beneficiaries with generic-only gap coverage and full gap coverage in 2008, the third year of the Part D program.

Methods: We conducted telephone interviews in a stratified random sample of Medicare Advantage beneficiaries in an integrated delivery system, age 65+ (N=1201, response rate 70.0%). We sampled equal numbers of beneficiaries with generic-only gap coverage, and beneficiaries with no gap due to low income subsidies (LIS) or employer sponsored insurance (ESI). Beneficiaries reaching the gap threshold in 2008 ($2,510 in total drug spending) were oversampled. We examined three cost responses: cost-cutting strategies (e.g., switching to cheaper medications), decreasing adherence (e.g., not refilling a prescription), and experiencing financial burdens (e.g., going without necessities). We used multivariate logistic regression and adjusted for sociodemographic and clinical characteristics and 2008 drug costs. All analyses and percentages are weighted for sampling proportions.

Results: An estimated 18.4% of beneficiaries reported using a cost-cutting strategy, 2.9% decreased adherence, and 9.6% experienced financial burdens. After adjusting for covariates, compared with beneficiaries with generic-only gap coverage, LIS and ESI beneficiaries were significantly less likely to report each of the cost responses: cost-cutting strategies (OR=0.50, 95% CI: 0.31–0.83 for LIS and OR=0.58, 95% CI: 0.39–0.87 for ESI beneficiaries), decreased adherence (OR=0.36, 95% CI: 0.14–0.92 for LIS and OR=0.21, 95% CI: 0.07–0.62 for ESI beneficiaries), and financial burden (OR=0.51, 95% CI: 0.29–0.89 for LIS and OR=0.41, 95% CI: 0.23–0.73 for ESI beneficiaries).

Conclusions: Overall reports of cost-related non-adherence were lower compared with earlier reports among beneficiaries with no gap coverage; nevertheless beneficiaries with generic-only gap coverage were more likely to report non-adherence and financial burdens compared with beneficiaries with no gap. However, beneficiaries with no gap were also less likely to switch to cheaper medications, suggesting a need for additional efforts to guide beneficiaries’ drug choices.