Original article| Volume 24, ISSUE 4, e435-e445, July 2014

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Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries



      For women living with osteoporosis, high out-of-pocket (OOP) drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis OOP medication costs and female Medicare beneficiaries' initiation of osteoporosis drug therapy.


      We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in stand-alone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the OOP costs and initiation of oral osteoporosis drug therapy during the year of diagnosis.


      Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries' OOP costs were not associated with the initiation of drug therapy for osteoporosis. However, there were significant racial disparities in beneficiaries' initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than Whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points, respectively, more likely to initiate drug therapy than Whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries.


      Access barriers for drug therapy initiation may be driven by factors other than patients' OOP costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies.
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      Chia-Wei Lin, MS, is a PhD student in the pharmaceutical economics and policy program at the University of Southern California. Her research focuses on the economic and health outcomes evaluation for pharmaceutical products.


      Pinar Karaca-Mandic, PhD, is an assistant professor in the Division of Health Policy and Management at the University of Minnesota, School of Public Health, and faculty research fellow at the National Bureau of Economic Research. Her research focuses on health insurance benefit design, health insurance market, and health care policy and regulations.


      Jeffery McCullough, PhD, is an assistant professor in the Division of Health Policy and Management at the University of Minnesota, School of Public Health. His research focuses on the health information technology economics and the pharmaceutical industry.


      Lesley Weaver, MPP, is a PhD student in the health services research, policy and administration program at the University of Minnesota, School of Public Health, Division of Health Policy and Management.