Clinical Investigation
Congestive Heart Failure
The Medicare drug benefit (Part D) and treatment of heart failure in older adults

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Background

Adherence to pharmacotherapy for heart failure is poor among older adults in part because of high prescription drug costs. We examined the impact of improvements in drug coverage under Medicare Part D on utilization of, and adherence to, medications for heart failure in older adults.

Methods

We used a quasi-experimental approach to analyze pharmacy claims for 6,950 individuals aged ≥65 years with heart failure enrolled in a Medicare managed care organization 2 years before and after Part D's implementation. We compared prescription fill patterns among individuals who moved from limited (quarterly benefits caps of $150 or $350) or no drug coverage to Part D in 2006 with those who had generous employer-sponsored coverage throughout the study period.

Results

Individuals who previously lacked drug coverage filled approximately 6 more heart failure prescriptions annually after Part D (adjusted ratio of prescription counts = 1.36, 95% CI 1.29-1.44, P < .0001 relative to the comparison group). Those previously lacking drug coverage were more likely to fill prescriptions for an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker plus a β-blocker after Part D (adjusted ratio of odds ratios = 1.73, 95% CI 1.42-2.10, P < .0001) and more likely to be adherent to such pharmacotherapy (adjusted ratio of odds ratios = 2.95, 95% CI 1.85-4.69, P < .0001) relative to the comparison group.

Conclusions

Medicare Part D was associated with improved access to medications and adherence to pharmacotherapy in older adults with heart failure.

Section snippets

Study design, sample, and source of data

We obtained pharmacy and medical claims, and enrollment data for patients with heart failure from a large health insurer in Pennsylvania for 2003-2007. Using Part D's January 2006 implementation as a natural experiment, we compared medication utilization among 4 groups with different pharmacy benefits in 2004-2005. Two groups had quarterly pharmacy benefit limits of $150 or $350, depending solely on their county of residence (referred to hereafter as the $150 cap and $350 cap groups). A third

Results

The groups who previously had no or limited coverage were slightly older (1-2 years) and more likely to be female than the No cap group that had consistent drug coverage throughout (P < .05) (Table I). The No coverage and $150 cap groups were slightly more likely to live in areas with higher poverty levels (P < .05). There were some differences in the prevalence of comorbid mental health and medical conditions: compared with the No cap group, the No coverage group was more likely to have

Discussion

This is the first study to demonstrate that Medicare Part D was associated with increased use of heart failure medications. These findings are consistent with a major goal of the policy, which was to reduce financial barriers to medication access among the elderly. Previous studies have shown that, before Part D, rates of prescribing of and adherence to pharmacotherapy regimens for heart failure were suboptimal.19, 20 For example, only 43.6% of incident heart failure patients in the

References (28)

  • MurrayM.D. et al.

    Pharmacist intervention to improve medication adherence in heart failure: a randomized trial

    Ann Intern Med

    (2007)
  • PfistererM. et al.

    BNP-guided vs symptom-guided heart failure therapy: the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized trial

    JAMA

    (2009)
  • HoP.M. et al.

    Medication adherence: its importance in cardiovascular outcomes

    Circulation

    (2009)
  • ColeJ.A. et al.

    Drug copayment and adherence in chronic heart failure: effect on cost and outcomes

    Pharmacotherapy

    (2006)
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