Responses to Medicare Drug Costs among Near-Poor versus Subsidized Beneficiaries
Article first published online: 13 MAY 2013
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 5, pages 1653–1668, October 2013
How to Cite
Fung, V., Reed, M., Price, M., Brand, R., Dow, W. H., Newhouse, J. P. and Hsu, J. (2013), Responses to Medicare Drug Costs among Near-Poor versus Subsidized Beneficiaries. Health Services Research, 48: 1653–1668. doi: 10.1111/1475-6773.12062
- Issue published online: 16 SEP 2013
- Article first published online: 13 MAY 2013
- The Kaiser Permanente Community Benefit Program
- National Institute on Aging
- low-income subsidies;
- drug cost-sharing
There is limited information on the protective value of Medicare Part D low-income subsidies (LIS). We compared responses to drug costs for LIS recipients with near-poor (≤200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS.
Data Sources/Study Setting
Medicare Advantage beneficiaries in 2008.
We examined three drug cost responses using multivariate logistic regression: cost-reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities).
Telephone interviews in a stratified random sample (N = 1,201, 70 percent response rate).
After adjustment, a comparable percentage of unsubsidized near-poor (26 percent) and higher income beneficiaries reported cost-reducing behaviors (23 percent, p = .63); fewer LIS beneficiaries reported cost-reducing behaviors (15 percent, p = .019 vs near-poor). Unsubsidized near-poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent, p = .049) and LIS beneficiaries (3.1 percent, p = .027). Near-poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent, p = .050) and LIS beneficiaries (11 percent, p = .015).
Low-income subsidies provide protection from drug cost-related nonadherence and financial stress. Beneficiaries just above the LIS income threshold are most at risk for these potentially adverse behaviors.