Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.

Glynn A, Hernandez I, Roberts ET. Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes. Health services research. 2022 Oct 1; 57(5):1136-1144.

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Abstract:

OBJECTIVE: The objective is to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. The LIS reduces out-of-pocket drug costs for low-income beneficiaries; however, not all LIS-eligible individuals are enrolled. Take-up of the LIS, and consequences of forgoing this benefit among beneficiaries with diabetes, remains unknown. DATA SOURCES: Health and Retirement Study linked to Medicare administrative data from 2008 to 2016. STUDY DESIGN: We conducted two analyses among beneficiaries with diabetes. First, we estimated LIS take-up stratified by income ( = 100% of the Federal Poverty Level [FPL] and > 100% to = 150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes > 100% to = 150% of FPL), we conducted propensity score-weighted regression analyses to compare out-of-pocket costs, the prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. DATA COLLECTION/DATA EXTRACTION: N/A. PRINCIPAL FINDINGS: Among Medicare beneficiaries with diabetes, 68.1% of those with incomes > 100% to = 150% of FPL received the LIS, while 90.3% with incomes = 100% of FPL received the LIS. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518; 95 [in USD]% CI: $370 [in USD], $667 [in USD]; p? < 0.001), filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs (95% CI: -11.1, -3.5; p? < 0.001), and were 8.9 percentage points more likely to report skipping drugs due to cost (95% CI: 0.3, 18.0; p  =  0.04), all compared to LIS enrollees. CONCLUSIONS: Despite providing substantial financial assistance with prescription drug costs, the LIS is under-utilized among beneficiaries with chronic conditions requiring routine medication use. As policy makers discuss Part D reforms to address rising out-of-pocket drug costs, they should consider strategies to increase participation in existing programs that alleviate cost burdens among low-income Medicare beneficiaries.