Nonelderly Disabled Still Face Significant Medicare Prescription Cost Barriers

Prescription drug coverage under the Medicare Part D plan was implemented in 2006 and led to nationwide improvements in medication affordability.

Studies have shown, however, that economic relief has been delayed and modest for the permanently disabled, largely because this very vulnerable population experiences high rates of poverty and cost-related medication nonadherence (CRN).

Authors of a study published in Medical Care said that in 2007, the rates of CRN and spending less on basic needs to afford medication were 3 times higher for the permanently disabled than they were for the elderly. Over 8 million people under age 65 qualify for Medicare due to permanent disabilities, and they tend to have low incomes and high comorbidity rates.

One-third live below the poverty line, the authors said, and over half have multiple chronic conditions, both physical and mental.

To evaluate the effect of Medicare Part D coverage for this vulnerable population, researchers investigated national trends in medication affordability among nonelderly disabled Medicare beneficiaries, stratified by morbidity burden.

Methods

This study used multivariate logistic regression analyses to estimate annual rates of medication affordability among nonelderly disabled participants in a nationally representative survey.

Data were derived from the 2006 to 2011 Access to Care (ATC) files of the Medicare Current Beneficiary Survey (MCBS), a longitudinal, rotating panel survey administered by the Centers for Medicare & Medicaid Services (CMS). The sample included all eligible community-dwelling disabled adults aged 64 and younger (N = 6197 unique individuals).

Accounting for overlapping panels and applying the annual cross-sectional survey weights provided by the MCBS, each annual sample was determined to represent an average of 7,030,410 beneficiaries nationally.

In-person interviews included a set of questions on the affordability of medications, in use and tested for validity and reliability since 2004.

How Has Part D Coverage Affected Prescription Affordability for the Disabled?

There was a slight decrease in financial burden observed immediately after the implementation of Part D, but it plateaued and even rose slightly in later years.

More than 40% of disabled beneficiaries experienced CRN in 2005; this reduced to 35.6% in 2006 and 31.6% in 2007 with the introduction of Medicare Part D. That was the end of the downward trend, however. In subsequent years, CRN for the disabled rose slightly in 2008, declined slightly in 2009, and settled at 34% in 2010 and 33.7% in 2011.

Beneficiaries who reported forgoing basic needs in order to afford medication followed a similar trend. This burden declined from affecting 24.5% of respondents in 2005 to 19% in 2007 with the introduction of Part D, and reached its lowest point in 2008 at a rate of 17.7%.

Since then, however, prevalence went slightly up in 2009, slightly down in 2010, and ended near 2006 levels at 21.6% in 2011.

Researchers found a definite association between comorbidity and financial burden. In 2011, sicker disabled beneficiaries (defined as having 3 or more morbidities) experienced a 37.3% rate of CRN (versus 28.1% among the less sick), and 25.4% of those with high morbidity had to sacrifice basic needs to afford medicine, compared with 15.7% of those with lower morbidity.

Comparing 2011 figures with 2007, there were no significantly detectable differences between CRN and spending less on basic needs.

Implications of Drug Affordability for the Permanently Disabled

After a modest early impact, authors observed no further trend in improving drug affordability for the nonelderly disabled under Medicare Part D. During the 2006 to 2011 observation period, the researchers concluded that more than one-third of permanently disabled beneficiaries experienced CRN, and about one-fifth cut back on basic needs spending to be able to afford medication.

Authors noted other factors may help explain their observations, such as the economic recession of 2008 and insurance changes that have made Part D prescription coverage less generous.

Investigators called for policy solutions to provide more financial relief for vulnerable disabled Medicare beneficiaries, especially those with many comorbidities. The authors suggested more vigorous automatic enrollment for the Part D low-income subsidy and personal assistance from doctors and pharmacists to weigh and select the most cost-effective prescription options.