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Certain Medicare beneficiary subgroups failed to fill prescriptions before Part D implementation, new data show

Saturday, August 16 2008 | Comments

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What's This? Although most Medicare beneficiaries filled or refilled recommended prescriptions prior to the implementation of the Medicare Part D benefit, more than 1.5 million enrollees did not, new findings reveal. This was especially true among younger enrollees eligible through Social Security Disability Insurance, dual eligibles and those with multiple chronic conditions.

Using responses to the Medicare Current Beneficiary Survey from the 2004 fall interview, researchers assessed the rates of self-reported failure to fill at least one prescription, reasons for not filling, characteristics of beneficiaries who did not fill and which prescriptions were most commonly not filled among 14,464 beneficiaries.

The survey revealed that 664 respondents (4.6 percent) reported that they did not fill or refill certain medicines prescribed to them. This translated to an estimated 1.6 million Medicare beneficiaries who had failed to fill or refill one or more prescriptions in 2004.

High drug costs were cited by 55.5 percent of the respondents, or an estimated 898,910 beneficiaries, followed by a lack in insurance coverage (20.2 percent of respondents; an estimated 326,970 beneficiaries). Other reasons for failing to fill prescriptions included the belief that the drug was not necessary for the condition (18 percent), fear of medicine reactions/contraindications (11.8 percent) and dislike of taking medicines (6.8 percent).

Certain subpopulations were significantly more likely to report not filling prescriptions. For example, 10.4 percent of the Medicare beneficiaries aged 18 to 64 years eligible through SSDI versus 3.3 percent of the beneficiaries aged 65 years or older reported failure to fill or refill prescriptions in 2004. A greater proportion of the dually eligible Medicaid beneficiaries (6.3 percent) versus those not covered by Medicaid (4 percent) did not fill or refill prescriptions.

The investigators evaluated the likelihood of not filling prescriptions according to nine categories of chronic conditions, finding that beneficiaries with psychiatric conditions had the highest failure to fill rate (8 percent), followed by patients with emphysema, asthma or chronic obstructive pulmonary disorder (6.6 percent); arthritis (5.2 percent); or cardiovascular disease (5.2 percent). Furthermore, the more chronic diseases a respondent had, the more likely he/she failed to fill at least one prescription. The rate was 5.9 percent among the beneficiaries with four conditions or more, while the rate was 2.5 percent among the respondents with no chronic conditions.

In total, 993 drugs were identified among the reports of failure to fill. Central nervous system drugs were most frequently identified in the failure to fill reports (23.6 percent; n=234). Other prescription classes that were commonly unfilled included cardiovascular agents (18.3 percent) and endocrine/metabolic drugs (6.5 percent). The study authors stressed that while it may not be harmful to skip filling/refilling prescriptions for nonsteroidal anti-inflammatory drugs, it can be problematic to skip filling/refilling antidepressants.

"Targeted health education efforts and/or insurance subsidies may reduce these disparities and improve adherence," the researchers wrote.

They added that these data could be used as a baseline to measure nonadherence trends after the Part D program implementation.

The study was published in the July/August issue of the Journal of Managed Care Pharmacy.

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