Cancer history, insurance coverage, and cost-related medication nonadherence in Medicare beneficiaries, 2013-2018

BACKGROUND: Cancer survivors are at risk of financial hardships and cost-related medication nonadherence, particularly among those without adequate insurance coverage. OBJECTIVE: To examine the association between cancer history and cost-related medication nonadherence, as well as the association between insurance coverage and nonadherence among Medicare beneficiaries. METHODS: We used the 2013-2018 Medicare Current Beneficiary Survey Public Use File, a survey on the health, health service utilization, access to care, and satisfaction among a nationally representative sample of Medicare beneficiaries. Cost-related medication nonadherence was defined as often or sometimes reporting any of the following: (1) took smaller dose of medication, (2) skipped doses to make medication last, (3) delayed characteristics of the respondents, cancer surmedication because of cost, and (4) not get vivors were more likely than those without a medication because of cost. Logistic regreshistory of cancer to report cost-related medi-sion was used to estimate the odds ratio of cation nonadherence (adjusted OR=1.10; 95% cost-related nonadherence associated with CI=1.02-1.19). Having unsubsidized Part D—cancer history, adjusting for survey year and Part D without the low-income subsidy—was sociodemographic characteristics of the associated with a greater likelihood of report-respondents, including age, sex, race and ing cost-related medication nonadherence ethnicity, highest grade completed, income (adjusted OR=1.63, 95% CI=1.49-1.78), while level, marital status, and number of chronic having subsidized Part D was not (adjusted conditions. We also included Medicare OR=0.96; 95% CI=0.85-1.08). Finally, being Part D, an interaction between Part D and on Medicare Advantage was associated with the low-income subsidy, and Medicare lower likelihood of reporting cost-related Advantage in the model to examine the nonadherence compared with traditional fee-effect of insurance coverage on cost-related for-service Medicare (adjusted OR=0.86; 95% nonadherence. CI=0.80-0.92). RESULTS: From 2013 to 2018, there were CONCLUSIONS: Expanding the low-income 12,492 cancer survivors and 53,262 responsubsidy and capping out-of-pocket drug dents without a history of cancer in our expenditure can be effective policy options sample, and 16.5% reported cost-related to reduce cost-sharing burden and cost-medication nonadherence. After adjusting for related nonadherence.