Guideline-Recommended Therapy Remains Costly for Older Adults With Multiple Chronic Conditions

Out-of-pocket costs for guideline-recommended medications for older adults with chronic conditions have decreased over the last 10 years, but they remain high and burdensome, according to a new study published in JAMA Internal Medicine. 

Most adults 65 years and older have multiple chronic conditions, and managing these conditions with prescription drugs is costly; this is especially true for older adults with financial insecurity who have limited sources of income.

In this retrospective cross-sectional study, the investigators used 2009 and 2019 Medicare prescription drug plan files to estimate hypothetical out-of-pocket costs associated with guideline-recommended outpatient medications for the initial treatment of eight common chronic diseases that affect the older population  (atrial fibrillation, chronic obstructive pulmonary disease [COPD], heart failure with reduced ejection fraction, hypercholesterolemia, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes) in patients enrolled in Medicare Advantage or stand-alone Medicare Part D plans (PDPs).

In total, they analyzed 3,599 Medicare PDPs in 2009, of which 1,998 were Medicare Advantage plans and 1,601 were stand-alone plans, and 3,618 Medicare PDPs in 2019, of which 2,719 were Medicare Advantage plans and 899 were stand-alone plans. The primary endpoint of interest was defined as annual out-of-pocket costs for each chronic condition, adjusted for inflation to 2019 dollars.

A ‘Substantial Financial Burden’

According to the results, among older adults enrolled in any Medicare PDP in 2019, the average annual out-of-pocket costs for individual conditions varied; from $32 on the low end for guideline-recommended management of osteoporosis (a decrease from $128 in 2009) to $1,579 on the high end for guideline-recommended management of atrial fibrillation (an increase from $91 in 2009).

Moreover, the results showed that for an older adult with a cluster of five commonly comorbid conditions (COPD, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes) enrolled in any PDP, the average out-of-pocket cost in 2019 was $1,999; a cost representing a 12% decrease from $2,284in 2009. For older adults with all eight chronic conditions  enrolled in any PDP, the median out-of-pocket cost in 2019 was $3,630; a 41% increase from $2,571 in 2009.

“Although costs generally decreased between 2009 and 2019, particularly with regard to conditions for which generic drugs were available, out-of-pocket costs remained high and may have presented a substantial financial burden for Medicare beneficiaries, especially older adults with conditions for which brand-name drugs were guideline recommended,” the researchers concluded.