Medicare Part D adherence gains eroding: study

The impact of Medicare’s Part D prescription drug benefit appears to be wearing off for many of its beneficiaries, a new study has found. In particular, elderly patients with four or more chronic conditions have lost most of the gains in adherence they saw in the years immediately following Medicare Part D’s implementation in 2006.

The study, which appears in the August issue of Health Affairs, uses data from the Medicare Current Beneficiary Survey to examine trends in nonadherence and find out whether beneficiaries are spending less on basic needs so as to pay for prescription medications. It found that while Part D did reduce nonadherence and foregoing spending on other necessities until about 2009, many of those gains are slipping.

In 2005, the year before Part D went into effect, about 14.9% of all Part D beneficiaries reported nonadherence due to the cost of medication. By 2009, the percentage had dropped to 10.2%, but in 2011 it was back up to 10.8%. Similarly, the percentage reporting having to forego other necessities in favor of medications went from 5.6% in 2007 to 4% in 2009 to 5.3% in 2011.

Among beneficiaries with four or more chronic conditions, the prevalence of nonadherence decreased from 15.1% in 2007 to 14.4% in 2009, but was back up to 17% in 2011. The percentage of those who said they gave up other necessities to afford their medications went from about 8% in 2007 to 6.5% in 2009 to 10.5% in 2011.

The authors offer several possible explanations for the reversal of the positive trends resulting from Part D’s implementation, including:

• the severe economic downturn that began in 2008. Among other consequences, the recession led to especially high rates of mortgage delinquency among the elderly, a factor associated with cost-related nonadherence.

• Reduced generosity in drug coverage, in the form of higher premiums and copays, and restrictions such as prior authorization requirements. While these and other benefit changes were intended to encourage the use of less-expensive medications, “they may have had the effect of introducing barriers to drug therapy and shifting the overall drug cost burden toward patients, particularly those with multiple chronic conditions,” the authors say.

To address the problem, the study’s authors recommend increased outreach to qualified people who may benefit from the Part D low-income subsidy, providing more help to beneficiaries in selecting a Part D plan that fits their financial situation, and encouraging physicians and pharmacists to use lower-cost therapies with comparable benefit-harm profiles whenever possible.