Journal of Health & Medical Economics

The High Cost-related Medication Non-adherence Rate among Medicare- Medicaid Dual-eligible Diabetes Patients

Context: Access barriers to effective medication treatment have been a persistent issue for millions of older Americans despite the establishment of Medicare Part D. Objective: We aimed to assess the prevalence rate of cost-related medication nonadherence (CRN) and the patterns of CRN behaviors in Medicare-Medicaid dual eligibles with diabetes. Design, setting, patients, interventions, and main outcome measures: We used data from the 2011 Medicare Current Beneficiary Survey, a nationally
representative sample of Medicare beneficiaries. Multivariate logistic regression analysis was performed to assess CRN rate, controlling for demographics and types of Medicare Part D plans.
Results: The CRN rate in dual-eligible diabetes patients was 21%, compared to 16% in non–dual-eligible diabetes patients (p<0.01). In 2011, the standardized prevalence rate of CRN in dual-eligible diabetes patients was 21%, of those with CRN 29% reported three or more types of CRN behaviors.
Conclusion: Contrary to the common belief that dual eligibles have better insurance coverage for medication due to the assistance from Medicaid to pay some of the out-of-pocket payments, the CRN rate among dual eligibles is high and patients often report multiple types of CRN behaviors. This demonstrates that cost is a significant access barrier for dual-eligible diabetes patients. More research is needed to improve the insurance benefit design and expand insurance coverage for this high-need, high-cost subpopulation.

Author(s):

Zhang JX and Meltzer DO

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