New Haven, CT—Out-of-pocket costs have a significant effect on medication adherence, which can be especially important for older adults with chronic conditions.
That is why a recent study in JAMA Internal Medicine came up with hypothetical annual out-of-pocket costs of guideline-recommended medications for the treatment of older adults with multiple chronic conditions in 2009 compared with 2019.
While the news generally was good—with decreasing costs—some exceptions exist. Yale University—led authors point out that in the cross-sectional study of hypothetical older adults with eight common chronic conditions enrolled in 3,599 Medicare prescription drug plans (PDPs) in 2009 and 3,618 Medicare PDPs in 2019, the median inflation-adjusted out-of-pocket costs for guideline-recommended medications decreased between 2009 and 2019.
The exception was in costs for conditions for which brand-name medications without generic alternatives became guideline-recommended. The biggest increase in relative costs over the decade was for patients who had the most chronic conditions, especially if some cardiovascular diseases were present.
Specifically, for a group of common comorbid conditions—chronic obstructive pulmonary disease (COPD), hypertension, osteoarthritis, osteoporosis, and type 2 diabetes—the median annual cost was $1,999 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," the researchers explain.
Background information in the articles notes that most adults aged 65 years or older have multiple chronic conditions. "Managing these conditions with prescription drugs can be costly, particularly for older adults with limited incomes," the article notes.
The retrospective, cross-sectional study used 2009 and 2019 Medicare PDP formulary files to estimate annual out-of-pocket costs among hypothetical patients enrolled in Medicare Advantage or stand-alone Medicare Part D plans.
The study team examined costs associated with guideline-recommended medications for eight of the most common chronic diseases–atrial fibrillation, COPD, heart failure with reduced ejection fraction, hypercholesterolemia, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes. Researchers also looked at two clusters of commonly comorbid conditions.
The main outcomes and measures were defined as annual out-of-pocket costs for each chronic condition, inflation-adjusted to 2019 dollars.
Results indicated that for an older adult enrolled in any Medicare PDP in 2019, the median annual out-of-pocket costs for individual conditions ranged 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 $1,579 (IQR, $1,524-$2,229) for guideline-recommended management of atrial fibrillation (an increase from $91 [IQR, $73-$124] in 2009).
The estimate for an older adult with a cluster of five commonly comorbid conditions (COPD, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes) enrolled in any PDP, the median out-of-pocket cost in 2019 was $1,999 (IQR, $1,630-$2,564), a 12% decrease from $2,284 (IQR, $1,920-$3,107) in 2009.
If older adults had all eight chronic conditions (atrial fibrillation, COPD, diabetes, hypercholesterolemia, heart failure, hypertension, osteoarthritis, and osteoporosis) enrolled in any PDP, the study team estimated the median out-of-pocket cost in 2019 at $3,630 (IQR, $3,234-$5197), a 41% increase from $2,571 (IQR, $2,185-$3,719) in 2009.
"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," the authors advise. "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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