Supplemental insurance and use of effective cardiovascular drugs among elderly Medicare beneficiaries with coronary heart disease

Context Cost-sharing in US prescription drug coverage plans for elderly per sons varies widely. Evaluation of prescription drug use among elderly perso ns by type of health insurance could provide useful information for designi ng a Medicare drug program.. Objective To determine use of effective cardiovascular drugs among elderly per sons with coronary heart disease (CHD) by type of health insurance. Design, Setting, and Patients Cross-sectional evaluation of 1908 community- dwelling adults, aged 66 years or older, with a history of CHD or myocardia l infarction from the 1997 Medicare Current Beneficiary Survey, a nationall y representative sample of Medicare beneficiaries. Main Outcome Measures Use of 3-hydroxy-3-methylglutaryl coenzyme A reductas e inhibitors (statins), beta -blockers, and nitrates, and out-of-pocket exp enditures for prescription drugs, stratified by type of health insurance: M edicare without drug coverage (Medicare only or self-purchased supplemental insurance) or with drug coverage (Medicaid, other public program, Medigap, health maintenance organization, or employer-sponsored plan). Results Statin use ranged from 4.1% in Medicare patients with no drug cover age to 27.4% in patients with employer-sponsored drug coverage (P<.001). Le ss variation between these 2 types occurred for <beta>-blockers (20.7% vs 3 6.1%; P=.003) and nitrates (20.4% vs 38.0%; P=.005). In multivariate analys es, statin use remained significantly lower for patients with Medicare only (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.05-0.49) and beta -blocker use was lower for Medicaid patients (OR, 0.55; 95% Cl, 0.34-0.88) vs those with employer-sponsored coverage. Nitrate use occurred less freque ntly in persons lacking drug coverage (patients with Medicare only, P=.049; patients with supplemental insurance without drug coverage, P=.03). Patien ts with Medicare only spent a much larger fraction of income on prescriptio n compared with those with employer-sponsored drug coverage (7.9% vs; 1.7%; adjusted P<.001). Conclusion Elderly Medicare beneficiaries with CHD who lack drug coverage h ave disproportionately large drug expenditures and lower use rates of stati ns, a class of relatively expensive drugs that improve survival.