Disabled Patients Who Fail to Take Medications Due to Cost Make More Emergency Visits

Disabled patients covered by Medicare who reported non-adherence to prescribed medications due to cost were significantly more likely to visit emergency departments than beneficiaries who adhered to medications.

Although previous studies have shown that the Medicare Part D prescription drug program has helped reduce medication costs as well as cost-related medication non-adherence among elderly beneficiaries, the results of a new study suggest that these effects have not been as strong among disabled patients. The study, published online on May 28, 2013, in Annals of Emergency Medicine, found that disabled Medicare beneficiaries who cannot afford their prescriptions are more likely to visit an emergency department than disabled patients who can afford their medications, as well as elderly patients regardless of their ability to afford their medications.

In a retrospective cohort study, responses from the 2006 and 2007 Medicare Current Beneficiary Survey were analyzed for self-reported non-adherence to medication due to cost. The researchers also collected health care claims on both inpatient and outpatient emergency department visits for a year following the survey. Patients included in the study were continuously enrolled in Medicare Parts A and B during this time.

Cost-related non-adherence in patients who reported it was categorized as either mild or severe. Skipping or reducing doses, or intentionally putting off filling of prescriptions due to cost was categorized as mild cost-related medication non-adherence. Failure to fill prescriptions at all because of cost qualified as severe cost-related medication non-adherence. Both non-adherence groups were compared with beneficiaries who reported no cost-related non-adherence. Multivariate logistic regression was used to assess the correlation between emergency department visits and cost-related non-adherence.

Approximately 7.5% of the 7177 Medicare beneficiaries included in the sample reported mild cost-related medication non-adherence, and approximately 8% reported severe cost-related medication non-adherence. About 39% of patients with severe cost-related medication non-adherence experienced at least 1 emergency department visit during the year covered by the study, compared with just 28% of patients with no cost-related medication non-adherence.

In addition, disabled patients younger than 65 with severe cost-related medication non-adherence were more likely than any other group to visit the emergency department. The association between cost-related medication non-adherence among disabled patients and emergency department visits remained significant even after the results were adjusted for other factors including demographics and medical history of other conditions.

The researchers note that they are unsure how the Patient Protection and Affordable Care Act and State Pharmaceutical Assistance programs will affect cost-related medication non-adherence. However, they suggest that specific policies to help reduce medication costs specifically for disabled Medicare patients may be needed.