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Chronic Illness

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Lack of insurance coverage is not the only barrier to medication access among older Americans with chronic conditions

Prescription drug benefits are not the only answer to improve drug access among sick and indigent elderly Medicare patients, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS10318). One-fourth of elderly Medicare+Choice enrollees without a prescription drug benefit reported difficulty affording medications compared with the 17 percent who had medication coverage. However, lower income, fewer assets, and worse health also independently predicted greater difficulty affording medications, irrespective of prescription drug coverage.

Barry Saver, M.D., M.P.H., of the University of Washington, and his colleagues analyzed survey and administrative data for 4,492 Medicare+Choice enrollees aged 67 and older with at least one chronic medical condition who were enrolled in a predominantly group-model health maintenance organization in 2000. They examined difficulty affording medications and methods of coping with medication costs.

About one-fifth of respondents reported difficulty affording their medications some of the time to all of the time. Stretching medications to make them last longer was the most commonly reported coping mechanism, cited by 12 percent of those surveyed. Only 3 percent reported obtaining medications in another country. After adjustment for other factors, 24 percent of people with fair or poor health status reported difficulty affording their medications compared with 4 percent of those in excellent health.

Individuals with annual incomes below $20,000 were much more likely to be unable to afford medications some of the time than those with incomes of $50,000 or more. Similarly, those whose assets were estimated at less than $10,000 were more than twice as likely to say they sometimes were unable to afford medications as those with $10,000 or more in assets. Higher out-of-pocket spending predicted greater difficulty affording medications but not stretching out medications.

Details are in "Seniors with chronic health conditions and prescription drugs: Benefits, wealth, and health," by Dr. Saver, Mark P. Doescher, M.D., M.S.P.H., J. Elizabeth Jackson, M.A., and Paul Fishman, Ph.D., in Value In Health 7(2), pp. 133-143, 2004.

Editor's Note: Another study on a related topic showed substantial net health plan savings from reference drug pricing for angiotensin-converting enzyme inhibitors in elderly British Columbia residents. For more details, see Schneeweiss, S., Dormuth, C., Grootendorst, P., and others (2004, July). "Net health plan savings from reference pricing for angiotensin-converting enzyme inhibitors in elderly British Columbia residents." (AHRQ grant HS10881). Medical Care 42, pp. 653-660.

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