Senior Stroke Survivors Cannot Afford
Life Saving Drugs Even with Medicare Part D
11% of stroke survivors said they weren’t taking
their medications as prescribed because they couldn’t afford them
This study was in
2009. The Medicare Part D Program has been enhanced by the Affordable
Care Act to reduce the cost for those who need expensive drugs and fall
into the donut hole (read
Feb. 11, 2011 – Many senior citizens that have
survived a stroke and are covered by Medicare’s prescription drug
program – Part D – cannot afford the medications they need to prevent
future strokes and other cardiovascular disease-related events,
according to research presented at the American Stroke Association’s
International Stroke Conference 2011. Young, uninsured stroke survivors
face the same obstacle.
Researchers evaluated whether cost-related
non-adherence to medication was a problem for stroke survivors even
after the 2006 implementation of Medicare Part D, the federal government
drug benefit that offers prescription drug coverage to all Medicare
“Federal programs to reduce cost-related
non-adherence to medication may not be working as intended, and a
resulting large number of stroke survivors are at risk for subsequent
stroke events,” said Deborah A. Levine, M.D., M.P.H., the study’s lead
author and an assistant professor of medicine at the University of
Michigan in Ann Arbor.
“Medicare Part D has not resolved the problem of
cost-related non-adherence to medication among Medicare beneficiaries
Despite the government prescription coverage, the
data suggest that medicine is still unaffordable for some disadvantaged
● 795,000 people suffer a stroke every year
● About 7 million US adults have had a stroke
● On average, every 40 seconds, someone in the United States has a
● Stroke incidence is decreasing for some populations, but increasing
● Every 4 minutes, someone dies of a stroke
● Over the past 10 years, the annual stroke death rate decreased over
● Women between 45 and 54 years of age are more than twice as likely
as men to have had a stroke.
● Stroke is a leading cause of serious, long-term disability in the
Levine and colleagues examined data from 2,656
stroke survivors 45 years and older, and assessed cost-related
non-adherence to prescription drugs during the past 12 months. The
patients had participated in the National Health Interview Survey
conducted between 2006 and 2009.
Researchers compared the patients’ responses with
survey data collected between 1998 and 2002, before Medicare Part D was
implemented. Survey respondents were asked: “Was there any time when you
needed prescription medicines but didn’t get them because you couldn’t
The survey only included stroke survivors living outside
institutional settings, such as hospitals or rehabilitation centers.
Researchers said more people appear to be surviving
stroke, but those enrolled in Medicare Part
D more often report they can’t always afford their
● In 2009, 11 percent or about 150,000 stroke
survivors reported cost-related non-adherence to their medications.
● Forty-two percent of Medicare beneficiaries
with stroke reported having Medicare Part D. However, cost-related
non-adherence to medication was twice as high among Medicare Part D
participants compared to those without the prescription drug benefit, 12
percent versus 6 percent. Many Medicare Part D participants were
low-income and in poor health.
● Cost-related non-adherence to medication
increased significantly among younger stroke survivors, particularly
those ages 45 to 54, but was unchanged among older stroke survivors.
Possible reasons include greater competing household costs or less
prescription drug coverage among younger stroke survivors, which the
researchers could not assess in their study.
● Cost-related non-adherence among uninsured
stroke survivors increased sharply, from 39 percent in 1998-2002 to 60
percent in 2006-09.
Physicians may be able to help reduce the risk of
recurrent stroke and other cardiovascular disease-related events among
their patients by simply asking them about their abilities to afford
their care, Levine said.
“Healthcare professionals need to screen for
cost-related barriers to medication in stroke survivors, particularly
those who are younger, uninsured or enrolled in Medicare Part D, and to
improve access to affordable medications for post-stroke patients who
need it,” she said.
“Interventions that provide affordable health
insurance and that reduce or eliminate costs for medications to prevent
recurrent stroke are needed for vulnerable stroke survivors who cannot
afford their medications. We hope to study whether full prescription
drug coverage of secondary preventive therapies for stroke survivors
will improve health outcomes and will be cost effective.”
The findings should be interpreted with caution
because the data are based on self-reports that didn’t include
information about stroke timing, the severity of patients’ strokes or
their attitudes and behaviors about taking medication, Levine said.
Co-authors are Lewis B. Morgenstern, M.D.; Kenneth
M. Langa, M.D., Ph.D. and John D. Piette, PhD. Disclosures are on the
abstract. There was no external funding.
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