What are the hypothetical annual out-of-pocket costs of guideline-recommended medications for the treatment of older adults with multiple chronic conditions in 2009 and 2019?
In this cross-sectional study of hypothetical older adults with 8 common chronic conditions enrolled in 3599 Medicare prescription drug plans in 2009 and 3618 Medicare prescription drug plans in 2019, the median inflation-adjusted out-of-pocket costs for guideline-recommended medications decreased between 2009 and 2019, with the exception of costs for conditions for which brand-name medications without generic alternatives became guideline recommended. For a cluster of 5 commonly comorbid conditions (chronic obstructive pulmonary disease, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes), the median annual cost was $1999 in 2019, a 12% decrease from 2009.
In this study, although inflation-adjusted out-of-pocket costs of guideline-recommended medications for older adults with multiple chronic conditions generally decreased between 2009 and 2019, costs remained high and may have presented a substantial financial burden for Medicare beneficiaries.
Most adults 65 years or older have multiple chronic conditions. Managing these conditions with prescription drugs can be costly, particularly for older adults with limited incomes.
To estimate hypothetical out-of-pocket costs associated with guideline-recommended outpatient medications for the initial treatment of 8 common chronic diseases among older adults with Medicare prescription drug plans (PDPs).
Design, Setting, and Participants
This retrospective cross-sectional study used 2009 and 2019 Medicare prescription drug plan formulary files to estimate annual out-of-pocket costs among hypothetical patients enrolled in Medicare Advantage or stand-alone Medicare Part D plans. A total of 3599 PDPs in 2009 and 3618 PDPs in 2019 were included after inclusion and exclusion criteria were applied. Costs associated with guideline-recommended medications for 8 of the most common chronic diseases (atrial fibrillation, chronic obstructive pulmonary disease [COPD], heart failure with reduced ejection fraction, hypercholesterolemia, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes), alone and in 2 clusters of commonly comorbid conditions, were examined.
Main Outcomes and Measures
Annual out-of-pocket costs for each chronic condition, inflation adjusted to 2019 dollars.
Among 3599 Medicare PDPs in 2009, 1998 were Medicare Advantage plans and 1601 were stand-alone plans; among 3618 Medicare PDPs in 2019, 2719 were Medicare Advantage plans and 899 were stand-alone plans. For an older adult enrolled in any Medicare PDP in 2019, the median annual out-of-pocket costs for individual conditions varied, from a minimum of $32 (IQR, $6-$48) for guideline-recommended management of osteoporosis (a decrease from $128 [IQR, $102-$183] in 2009) to a maximum of $1579 (IQR, $1524-$2229) for guideline-recommended management of atrial fibrillation (an increase from $91 [IQR, $73-$124] in 2009). For an older adult with a cluster of 5 commonly comorbid conditions (COPD, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes) enrolled in any PDP, the median out-of-pocket cost in 2019 was $1999 (IQR, $1630-$2564), a 12% decrease from $2284 (IQR, $1920-$3107) in 2009. For an older adult with all 8 chronic conditions (atrial fibrillation, COPD, diabetes, hypercholesterolemia, heart failure, hypertension, osteoarthritis, and osteoporosis) enrolled in any PDP, the median out-of-pocket cost in 2019 was $3630 (IQR, $3234-$5197), a 41% increase from $2571 (IQR, $2185-$3719) in 2009.
Conclusions and Relevance
In this cross-sectional study, out-of-pocket costs for guideline-recommended outpatient medications for the initial treatment of 8 common chronic diseases varied by condition. Although costs generally decreased between 2009 and 2019, particularly with regard to conditions for which generic drugs were available, out-of-pocket costs remained high and may have presented a substantial financial burden for Medicare beneficiaries, especially older adults with conditions for which brand-name drugs were guideline recommended.
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Zhou T, Liu P, Dhruva SS, et al. Assessment of Hypothetical Out-of-Pocket Costs of Guideline-Recommended Medications for the Treatment of Older Adults With Multiple Chronic Conditions, 2009 and 2019. JAMA Intern Med. Published online January 04, 2022. doi:10.1001/jamainternmed.2021.7457
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