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, Donglan Zhang Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine , Mineola, New York , USA Corresponding author: Donglan Zhang (Donglan.Zhang@nyulangone.org). Search for other works by this author on: Oxford Academic Jianing Xu Department of Statistics, Statistical Consulting Center, University of Georgia , Athens, Georgia , USA Search for other works by this author on: Oxford Academic Daniel B Hall Department of Statistics, Statistical Consulting Center, University of Georgia , Athens, Georgia , USA Search for other works by this author on: Oxford Academic Xianyan Chen Department of Statistics, Statistical Consulting Center, University of Georgia , Athens, Georgia , USA Search for other works by this author on: Oxford Academic Ming Chen Institute of Health Outcomes and Policy, University of Tennessee Health Science Center , Memphis, Tennessee , USA Center for Health System Improvement, University of Tennessee Health Science Center , Memphis, Tennessee , USA Search for other works by this author on: Oxford Academic Jasmin Divers Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine , Mineola, New York , USA Search for other works by this author on: Oxford Academic Jingkai Wei Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina , USA Search for other works by this author on: Oxford Academic Janani Rajbhandari-Thapa Department of Health Policy and Management, College of Public Health, University of Georgia , Athens, Georgia , USA Search for other works by this author on: Oxford Academic Davene R Wright Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute , Boston, Massachusetts , USA Search for other works by this author on: Oxford Academic Milla Arabadjian Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine , Mineola, New York , USA Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0001-5225-4721 Henry N Young Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia , Athens, Georgia , USA Search for other works by this author on: Oxford Academic
American Journal of Hypertension, Volume 37, Issue 8, August 2024, Pages 631–639, https://doi.org/10.1093/ajh/hpae062
Published:
10 May 2024
Article history
Received:
16 February 2024
Revision received:
05 April 2024
Accepted:
04 May 2024
Published:
10 May 2024
Corrected and typeset:
25 May 2024
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Donglan Zhang, Jianing Xu, Daniel B Hall, Xianyan Chen, Ming Chen, Jasmin Divers, Jingkai Wei, Janani Rajbhandari-Thapa, Davene R Wright, Milla Arabadjian, Henry N Young, The Association Between Type of Insurance Plan, Out-of-Pocket Cost, and Adherence to Antihypertensive Medications in Medicare Supplement Insurance Enrollees, American Journal of Hypertension, Volume 37, Issue 8, August 2024, Pages 631–639, https://doi.org/10.1093/ajh/hpae062
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Abstract
BACKGROUND
Medicare supplement insurance, or Medigap, covers 21% of Medicare beneficiaries. Despite offsetting some out-of-pocket (OOP) expenses, remaining OOP costs may pose a barrier to medication adherence. This study aims to evaluate how OOP costs and insurance plan types influence medication adherence among beneficiaries covered by Medicare supplement plans.
METHODS
We conducted a retrospective analysis of the Merative MarketScan Medicare Supplement Database (2017–2019) in Medigap enrollees (≥65 years) with hypertension. The proportion of days covered (PDC) was a continuous measure of medication adherence and was also dichotomized (PDC ≥0.8) to quantify adequate adherence. Beta-binomial and logistic regression models were used to estimate associations between these outcomes and insurance plan type and log-transformed OOP costs, adjusting for patient characteristics.
RESULTS
Among 27,407 patients with hypertension, the average PDC was 0.68 ± 0.31; 47.5% achieved adequate adherence. A mean $1 higher in 30-day OOP costs were associated with a 0.06 (95% confidence intervals [CIs]: −0.09 to −0.03) lower probability of adequate adherence, or a 5% (95% CI: 4%–7%) decrease in PDC. Compared with comprehensive plan enrollees, the odds of adequate adherence were lower among those with point-of-service plans (odds ratio [OR]: 0.69, 95% CI: 0.62–0.77), but higher among those with preferred provider organization (PPO) plans (OR: 1.08, 95% CI: 1.01–1.15). Moreover, the association between OOP costs and PDC was significantly greater for PPO enrollees.
CONCLUSIONS
While Medicare supplement insurance alleviates some OOP costs, different insurance plans and remaining OOP costs influence medication adherence. Reducing patient cost-sharing may improve medication adherence.
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/the-association-between-type-of-insurance-plan-out-of-pocket-cost-and-adherence-to-antihypertensive-medications-among-older-adults-with-medicare-supplement-insurance?utm_campaign=tidbitlinkshare&utm_source=ITP.
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blood pressure, high-deductible insurance plan, hypertension, managed care plan, Medicare supplement, medication adherence, antihypertensive medications, out-of-pocket expenses, insurance benefit design
© The Author(s) 2024. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
Issue Section:
ORIGINAL CONTRIBUTIONS > Health Economics
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