Volume 48 | Number 5 | October 2013

Abstract List

Vicki Fung Ph.D., Mary Reed, Mary Price, Richard Brand, William H. Dow Ph.D., Joseph P. Newhouse Ph.D., John Hsu M.D., M.B.A.


There is limited information on the protective value of Medicare Part D low‐income subsidies (). We compared responses to drug costs for recipients with near‐poor (≤200 percent of the Federal Poverty Level) and higher income beneficiaries without the .

Data Sources/Study Setting

Medicare Advantage beneficiaries in 2008.

Study Design

We examined three drug cost responses using multivariate logistic regression: cost‐reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities).

Data Collection

Telephone interviews in a stratified random sample ( = 1,201, 70 percent response rate).

Principal Findings

After adjustment, a comparable percentage of unsubsidized near‐poor (26 percent) and higher income beneficiaries reported cost‐reducing behaviors (23 percent,  = .63); fewer beneficiaries reported cost‐reducing behaviors (15 percent,  = .019 vs near‐poor). Unsubsidized near‐poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent,  = .049) and beneficiaries (3.1 percent,  = .027). Near‐poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent,  = .050) and beneficiaries (11 percent,  = .015).


Low‐income subsidies provide protection from drug cost‐related nonadherence and financial stress. Beneficiaries just above the income threshold are most at risk for these potentially adverse behaviors.