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AMBER CRONK, PHARMD., is Clinical Pharmacy Specialist, Department of Pharmacy, Kaiser Permanente Colorado, Aurora. TAMMY L. HUMPHRIES, PHARMD., is Clinical Pharmacy Specialist, Department. of Pharmacy, Kaiser Permanente Colorado, Aurora, and Clinical Assistant Professor, School of Pharmacy, University of Colorado, Denver. THOMAS DELATE, PH.D., is Clinical Pharmacy Research Scientist; and DENESE CLARK, B.S.PHARM., is Pharmacy Benefits and Compliance Manager, Department of Pharmacy, Kaiser Permanente Colorado, Aurora. BARBARA MORRIS, M.D., is Lead for Medicare, Kaiser Permanente Colorado, Colorado Permanente Medical Group, Westminster.

Address correspondence to Dr. Delate at the Department of Pharmacy, Kaiser Permanente Colorado, 16601 East Centretech Parkway, Aurora, CO 80011-9045 (tom.delate{at}kp.org).

Purpose. The mechanisms used by Medicare beneficiaries who reached their Part D drug-benefit threshold to cope with the costs of prescription drugs were evaluated. Methods. A retrospective review of integrated medical and pharmacy electronic records and a mail survey were utilized. Members of a Medicare Advantage plan continuously enrolled in 2006 in either a standard drug-benefit plan who reached their threshold by October 1, 2006 (study group) or a retiree drug subsidy plan without a threshold but by October 1, 2006, had reached the threshold in total drug spend (control group) were included. Data on members’ cost-lowering medication strategies, demographics, and socioeconomic status were analyzed. Results. Of the 1,472 questionnaires mailed, 622 (42%) were completed. Respondents in the study group were more likely than control respondents to be male, be married, own a home, report lower health status, and have a household income of <$30,000 (p < 0.05). There were no significant differences in age, race or ethnicity, and diagnoses between groups. Study group respondents were three times more likely than control group respondents to use a cost-lowering strategy (p < 0.001). Predictors of increased risk of using a medication cost-lowering strategy included study group assignment, age, health status, education, income, and purchase of a second-generation antipsychotic (p < 0.05). Conclusion. Respondents in the study group were three times more likely than respondents in the control group to report using a medication cost-lowering strategy. Respondents who were younger and had limited prescription drug coverage, lower household income, higher educational status, and poorer health status were at increased risk of adopting a cost-lowering strategy. Index terms: Costs; Data collection; Health benefit programs; Prescriptions