Change in Insurance Status and Cost-related Medication Non-adherence among Older U.S. Adults with Diabetes from 2010 to 2014.

Objective: Cost-related medication non-adherence (CRN) is a persistent challenge in health care in the U.S. Insurance coverage is a key determinant of access to medical care. We seek to examine the CRN rates among the older diabetes adult population in the U.S. from 2010 to 2014 when the major provisions of the Affordable Care Act came into force.

Research design and method: Data from the 2010 and 2014 Health and Retirement Study (HRS) were used for this study. CRN is identified if a respondent indicated taking less medication than was prescribed because of the cost, while diabetes is self-reported. We assessed the change in CRN rates by insurance status using multivariable logistic regression analysis.

Results: A total of 4,741 and 4,505 diabetes adults aged 50 or older in 2010 and 2014 were included in the analyses, representing 18.8 million and 19.1 million older adults with diabetes respectively. Overall, the percentage of dual-eligible diabetes patients increased from 8% to 10% and the uninsured decreased from 6% to 4% based on weighted population estimates. The CRN rates decreased from 27% to 21% and from 12% to 10% for those between 50 and 64, and 65 or older, respectively from 2010 to 2014. Race (African American) became a less significant factor for variations in CRN rates in 2014 (p=0.24).

Conclusions: There is an encouraging reduction in CRN rates after implementation of the ACA. However, CRN rates among diabetes patients between 50 and 65 of age remained high.