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Out-of-Pocket Costs May Predict Beta-Blocker Nonadherence in Medicare Enrollees With HF

June 10, 2019

Out-of-pocket spending for beta-blockers was significantly linked with a slight decline in medication adherence among Medicare Part D enrollees with heart failure, according to a study in the Journal of Managed Care & Specialty Pharmacy.

“This finding corroborates an earlier study in a commercially insured heart failure sample that found significantly increased odds of nonadherence for beta-blocker copays over $20,” researchers wrote. “It must be interpreted with caution, however, because most participants spent far less than 1% of their monthly income on a beta-blocker prescription.”

The finding stems from an analysis of drug spending and medication adherence among participants in the Medicare Current Beneficiary Survey. Researchers looked at data for community-swelling respondents with self-reported heart failure and Medicare Part D coverage. The study focused on beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs).

Among participants, whose median monthly income was $1472, the average percent of monthly income spent on a month-long medical supply was 0.22% for beta-blockers, 0.19% for ACE inhibitors, and 0.90% for ARBs. Adherence, which was gauged using a medication possession ratio, was 88.9% for beta-blockers, 88.5% for ACE inhibitors, and 90.4% for ARBs, researchers reported.

Despite low out-of-pocket costs and overall high adherence, beta-blocker nonadherence was significantly associated with higher out-of-pocket costs. For every 0.1 increase in percentage of income spent on beta-blockers, the odds of nonadherence increased 4%, according to the study.

Out-of-pocket costs were not associated with adherence for either ACE inhibitors or ARBs.

“If out-of-pocket spending indeed predicts nonadherence to beta-blockers in this population, then limits on patient liability for beta-blockers relative to income may increase efficiency, should costs rise,” researchers wrote. “That is because adherence to heart failure treatment is associated with fewer hospitalizations, longer cardiac event-free survival, and lower cumulative Medicare spending. Moreover, copay-attributable nonadherence has been linked to increased risk of hospitalization in heart failure.”

Jolynn Tumolo


McGee BT, Phillips V, Higgins MK, Butler J. Prescription drug spending and medication adherence among Medicare beneficiaries with heart failure. J Manag Care Spec Pharm. 2019;25(6):705-713.

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