• Kara Zivin, Jeanne M Madden, Amy J Graves, Fang Zhang, and Stephen B Soumerai.
• Department of Veterans Affairs, Health Services Research and Development (HSR&D), Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA. kzivin@umich.edu
• Am J Geriatr Psychiatry. 2009 Dec 1; 17 (12): 1068-76.

ContextCost-related medication nonadherence (CRN) was problematic for Medicare beneficiaries with depressive symptoms before Medicare Part D.ObjectiveTo estimate changes in CRN and forgoing basic needs to pay for drugs among Medicare beneficiaries with and without depressive symptoms following Part D implementation.Design And SettingThe authors compared changes in outcomes between 2005 and 2006 before and after Part D with changes between 2004 and 2005 using logistic regression to control for demographic characteristics, health status, and historical trends.ParticipantsThe community-dwelling sample of the Medicare Current Beneficiary Survey (N = 24,234).Main Outcome MeasuresSelf-reports of CRN (skipping or reducing doses and not obtaining prescriptions) and spending less on basic needs to afford medicines.ResultsThe unadjusted annual prevalence of CRN among beneficiaries with depressive symptoms was 27% (2004), 27% (2005), and 24% (2006), compared with 13%, 12%, and 9% among beneficiaries without depressive symptoms. The annual prevalence of spending less on basic needs was 22% (2004), 23% (2005), and 19% (2006), compared with 8%, 9%, and 5% among beneficiaries without depressive symptoms. Controlling for historical changes and demographic characteristics, CRN did not decline among beneficiaries with depressive symptoms compared with beneficiaries without depressive symptoms (ratio of Part D changes 0.98; 95% confidence interval [CI], 0.73-1.32). Respondents with depressive symptoms seemed less likely to spend less on basic needs compared with individuals without depressive symptoms (0.70; 95% CI, 0.49-1.01); however, this difference was not statistically significant.ConclusionsDespite a Medicare Part D goal to improve medication adherence among mentally ill beneficiaries, the disparity in economic access to medications between beneficiaries with and without depressive symptoms did not improve after the start of Part D.

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