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Objective: 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. Study Design: 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). Data Collection: Telephone interviews in a stratified random sample ( N = 1,201, 70 percent response rate). Principal Findings 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). Conclusions 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.


Fung, Vicki, Mary Reed, Mary Price, Richard Brand, William H. Dow, Joseph P. Newhouse, and John Hsu. "Responses to Medicare Drug Costs among Near-Poor versus Subsidized Beneficiaries." Health Services Research 48.5 (October 2013): 1653-1668.