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Cost-related Nonadherence by Medication Type among Medicare Part D Beneficiaries with Diabetes
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    Despite the rollout of Medicare Part D, cost-related non-adherence (CRN) among older adults remains a problem.


    To examine the rate and correlates of self-reported CRN among a population of older persons with diabetes.

    Research Design



    1,264 Part D patients with diabetes, who entered the coverage gap in 2006.


    Initial administrative medication lists were verified in computer-assisted telephone interviews, in which participants brought their medication bottles to the phone. Medications were classified into cardiometabolic (diabetes, hypertension, cholesterol-lowering), symptom relief, and “other.” Participants were asked if they had any cost-related non-adherence during 2006, and if so to which medication/s. We used the person-medication dyad as the unit of analysis, and tested a multivariate random effects logistic regression model to analyze the correlates of CRN.


    Approximately 16% of participants reported any CRN. CRN was more frequent for cholesterol-lowering medications [Relative risk 1.54, 95%CI 1.01-2.32] compared to medications taken for symptom relief. CRN was reported less frequently with increasing age above 75 years, compared to patients between 65 and 69. In addition, compared to those with incomes >$40,000, CRN risk for those with incomes <$25,000 was markedly higher [RR 3.05, 95%CI 1.99-4.65].


    In summary, we found high rates of CRN among Medicare beneficiaries with diabetes, particularly those with lower incomes. We observed more frequent CRN for cholesterol-lowering medications as compared to medications for symptom relief. Efforts to ensure medication affordability for this population will be important in boosting adherence to key medications.

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    K08 AG033630/AG/NIA NIH HHS/United States
    U58 DP923530/DP/NCCDPHP CDC HHS/United States
    U58 DP923530-05/DK/NIDDK NIH HHS/United States
    UL1 TR000124/TR/NCATS NIH HHS/United States
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