ISC: Stroke patients increasingly not taking meds, despite Part D coverage
Cost-related nonadherence continues to rise, particularly among stroke survivors aged 45 to 54 years or uninsured. Medicare beneficiaries with Part D coverage also have a higher risk of cost-related nonadherence and could possibly be the culprit of early Part D adopters, according to data presented at the 2011 American Heart Association/American Stroke Association's International Stroke Conference in Los Angeles today.

“Medication nonadherence is associated with increased risk of cardiovascular disease (CVD) events among patients with CVD,” the authors wrote. "Medicare Part D has not resolved the problem of cost-related non-adherence to medication among Medicare beneficiaries with stroke," said Deborah A. Levine, assistant professor in the department of internal medicine at the University of Michigan in Ann Arbor, Mich.

Levine and colleagues used data from the National Health Interview Survey (NHIS) from 2006 to 2009, which included 2,656 stroke survivors over the age of 45, to assess cost-related nonadherence to medication by age and insurance. The researchers also adjusted for socio-demographics and clinical factors using logistic regression. In addition, the researchers compared data from a previous time period, from 1998 to 2002.

The researchers identified 1,869 Medicare beneficiaries that represented 3.6 million stroke survivors, 42 percent of whom said they had Medicare Part D insurance. These Medicare Part D beneficiaries were more likely to have a lower income and a decreased health status.

The results showed that in 2009, 150,000 or 11 percent of all U.S. stroke survivors, reported cost-related nonadherence (CRN) to medications. When comparing data from 1998 to 2002 to the period from 2006 to 2009, the researchers reported that CRN to medication rose from 33 percent to 38 percent.

Among the uninsured stroke survivors, the researchers reported that the rates of cost-related nonadherence increased from 39 percent to 60 percent from 1998 to 2002 to 2006 to 2009.

Levine noted that despite prescription drug coverage from the government, the costs of prescriptions are still unaffordable.

"Healthcare professionals need to screen for cost-related barriers to medication in stroke survivors, particularly those who are younger, uninsured or enrolled in Medicare Part D, and to improve access to affordable medications for post-stroke patients who need it," she said.

Lastly, the researchers reported that the rate of nonadherence was twice as high in Medicare Part D participants compared with those who didn’t receive the benefit, 12 percent versus 6 percent.

"Interventions that provide affordable health insurance and that reduce or eliminate costs for medications to prevent recurrent stroke are needed for vulnerable stroke survivors who cannot afford their medications,” Levine concluded. “We hope to study whether full prescription drug coverage of secondary preventive therapies for stroke survivors will improve health outcomes and will be cost effective."

However, the authors said that the results should be interpreted with caution due to these data being based on self-reports that didn’t include information on stroke timing, stroke severity or patient attitudes toward medication.