Cost-Related Medication Nonadherence Among Elderly and Disabled Medicare Beneficiaries

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Abstract
Recent research corroborates anecdotal reports of elderly Americans stretching or not filling prescription medications owing to unaffordable out-of-pocket drug costs, a problem that contributed to the Congressional passage of a Medicare drug benefit.1-3 Such cost-related medication nonadherence (CRN), previously estimated to occur in about one fourth of the elderly,1 is associated with reductions in health status, increased risks of adverse cardiac events,4 and increased use of emergency and institutional services.5,6 No equivalent data exist for the approximately 6.3 million nonelderly disabled Americans eligible for coverage under Medicare,7 despite their higher burden of illness and use of medications, higher prevalence of poverty, and lower rates of drug coverage.8-11 In addition, little is known about how often disabled and elderly Americans engage in other drug cost reduction behaviors such as using generic drugs instead of brand name drugs, receiving free drug samples, shopping to compare drug prices, or buying medications on the Internet or from Canada.1,12,13 Information on the relationships between the burden of chronic illnesses, generosity of prescription drug coverage, and CRN is also limited. Prior to implementing the Medicare drug benefit, which aims to ameliorate financial access barriers faced by beneficiaries, obtaining baseline estimates of CRN will enable us to gauge the success of the program in the near and longer term.14