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October 10, 2001

Affordable Prescriptions for the Elderly

Author Affiliations

Author Affiliation: Department of Family and Community Medicine, University of California, San Francisco.

JAMA. 2001;286(14):1762-1763. doi:10.1001/jama.286.14.1762

Many clinicians have ordered a lipid panel for an elderly patient with diabetes and coronary artery disease, only to find that the statin drug prescribed 6 weeks ago has failed to lower the patient's low-density lipoprotein cholesterol level. "Are you taking your cholesterol pill every day?" the physician is likely to ask. "I hate to tell you, doc, but I just couldn't afford that pill. I never even bought it."

Recent studies indicate that lack of prescription drug coverage for Medicare beneficiaries is associated with lower use of essential medications and may lead to higher rates of adverse outcomes such as hospitalization and nursing home placement.1,2 These studies comprise a subset of the medical literature demonstrating that imposing out-of-pocket costs on patients reduces use of medical services, especially for low-income persons, with worsening of clinical processes or outcomes. In the Rand Health Insurance Experiment, patients contributing to the cost of their care had fewer ambulatory visits, fewer Papanicolaou tests, and higher diastolic blood pressures (for people with hypertension) compared with the free-care group, which had prescription drug coverage.3 In another survey, 37% of patients with uncontrolled hypertension reported difficulty paying for their medications compared with 16% of those whose blood pressure was controlled; the investigators concluded that pharmacy costs contributed to inadequate hypertension control.4