Prescription Drug Coverage, Health, and Medication Acquisition Among Seniors With One or More Chronic Conditions

Medical Care--November 2004
Vol. 42, No. 11
November 2004
Jackson, J.E., Doescher, M.P., Saver, B.G., and P. Fishman
pp. 1056-65

Background: The unabated rise in medication costs particularly affects older persons with chronic conditions that require long-term medication use, but how prescription benefits affect medication adherence for such persons has received limited study.

Objective: We sought to study the relationship among prescription benefit status, health, and medication acquisition in a sample of elderly HMO enrollees with 1 or more common, chronic conditions.

Research Design: We implemented a cross-sectional cohort study using primary survey data collected in 2000 and administrative data from the previous 2 years.

Subjects: Subjects were aged 67 years of age and older, continuously enrolled in a Medicare + Choice program for at least 2 years, and diagnosed with 1 or more of hypertension, diabetes, congestive heart failure, and coronary artery disease (n = 3073).

Measures: Outcomes were the mean daily number of essential therapeutic drug classes and refill adherence.

Results: In multivariate models, persons without a prescription benefit acquired medications in 0.15 fewer therapeutic classes daily and experienced lower refill adherence (approximately 7 fewer days of necessary medications during the course of 2 years) than those with a prescription benefit. A significant interaction revealed that, among those without a benefit, persons in poor health acquired medications in 0.73 more therapeutic classes daily than persons in excellent health; health status did not significantly influence medication acquisition for those with a benefit.

Conclusions: Coverage of prescription drugs is important for improving access to essential medications for persons with the studied chronic conditions. A Medicare drug benefit that provides unimpeded access to medications needed to treat such conditions may improve medication acquisition and, ultimately, health. 

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