Abstract
BACKGROUND
Cost-related underuse of medications is common among older adults, who seldom discuss medication costs with their physicians. Some older adults may use free drug samples or industry-sponsored patient assistance programs (PAP) in hopes of lowering out-of-pocket costs, although the long-term effect of these programs on drug spending is unclear.
OBJECTIVE
To examine older adults’ use of industry-sponsored strategies to reduce out-of-pocket drug costs and the association between doctor–patient communication and use of these programs.
DESIGN
Cross-sectional analysis of a 2006 nationally representative survey of Medicare beneficiaries.
PARTICIPANTS
14,322 community-dwelling Medicare beneficiaries age ≥65.
MAIN MEASURES
We conducted bivariate and multivariate analyses of the association between receipt of free samples and participation in PAPs with sociodemographic characteristics, health status, access to care, drug coverage, medication cost burden, and doctor–patient communication.
KEY RESULTS
51.4% of seniors reported receiving at least one free sample over the last 12 months and 29.2% reported receiving free samples more than once. In contrast, only 1.3% of seniors reported participating in an industry-sponsored PAP. Higher income respondents were more likely to report free sample receipt than low-income respondents (50.8% vs. 43.8%, p < 0.001) and less likely to report participating in a PAP (0.42% vs. 2.2%, p < 0.001). In multivariate analyses, those who reported talking to their doctor about the cost of their medications had more than twice the odds of receiving samples as those who did not (OR 2.17, 95% CI 1.95–2.42).
CONCLUSIONS
In 2006, over half of seniors in Medicare received free samples, but only 1.3% reported receiving any medications from a patient assistance program. Doctor–patient communication is strongly associated with use of these programs, which has important implications for clinical care regardless of whether these programs are viewed as drivers of prescription costs or a remedy for them.
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Acknowledgments
This work was supported in part by a VA HSR&D Career Development Award (09–207) (Gellad), a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (Huskamp), and by grants from the Agency for Healthcare Research and Quality (1RO1HS017695, R01HS018657), and the National Institute of Aging (1R01AG034056) and National Institute of Mental Health (RC1MH088510).
The original survey and data collection were funded by grants from the Commonwealth Fund and the Henry J. Kaiser Family Foundation.
Portions of an earlier version of this manuscript were presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Annual European Congress in Paris, France in 2009.
The contents of this paper are the sole responsibility of the authors and do not necessarily represent the views of the US Department of Veterans Affairs or the other funding sources.
Conflict of Interest
Dr. Safran and Ms. Li are employed by Blue Cross Blue Shield of Massachusetts (BCBSMA). BCBSMA is a not-for-profit health care company whose products include a variety of plans available to Medicare beneficiaries.
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Gellad, W.F., Huskamp, H.A., Li, A. et al. Use of Prescription Drug Samples and Patient Assistance Programs, and the Role of Doctor–Patient Communication. J GEN INTERN MED 26, 1458–1464 (2011). https://doi.org/10.1007/s11606-011-1801-y
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DOI: https://doi.org/10.1007/s11606-011-1801-y