The relationship between older adults' knowledge of their drug coverage and medication cost problems

OBJECTIVES: To determine whether chronically ill patients have gaps in knowledge about their prescription drug coverage and establish the relationship between gaps and medication cost problems. DESIGN: Nationwide, cross-sectional survey. SETTING: Nationwide survey conducted via the Internet. PARTICIPANTS: Three thousand one hundred nineteen adults aged 50 and older (1,400 of whom were aged >= 65) who had prescription drug coverage and at least one chronic illness. MEASUREMENTS: Patients were asked about features of their drug benefits and whether they had experienced problems due to medication costs in the prior year. RESULTS: Twenty-five percent of respondents reported not knowing their usual prescription copayments, and 41% did not know whether there were caps on their drug coverage. Nonwhite race and lower income were independent risk factors for lack of knowledge about these aspects of pharmacy benefits. Lack of knowledge regarding the limits of coverage was associated with a greater likelihood of cutting back on medication use because of cost pressures, forgoing basic needs because of medication costs, borrowing money to pay for prescriptions, and worrying about medication costs (all P <.05). CONCLUSION: Many older adults with prescription drug coverage do not know important features of their pharmacy benefits. Racial minorities and those with low incomes may have the greatest difficulty understanding coverage and as a result may be at greatest risk for underusing their benefits. Education about Medicare reforms and other efforts to increase prescription coverage should accompany these policies.