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Drug Coverage and Drug Purchases by Medicare Beneficiaries with Hypertension

Drug Coverage and Drug Purchases by Medicare Beneficiaries with Hypertension,” a New York University study published in the March/April issue of Health Affairs, reveals that older Medicare beneficiaries who lack prescription drug coverage may be less able than those with coverage to control serious health problems. Medicare does not cover most prescription drugs used on an outpatient basis, and many elderly patients cannot afford to buy coverage from other sources. The study confirms widespread anecdotal reports that cost barriers keep the elderly from purchasing needed medications. The study, authored by Jan Blustein, M.D., Ph.D., of NYU's Robert F. Wagner Graduate School of Public Service, shows that for Medicare beneficiaries age 65 and older with hypertension (high blood pressure), those with drug coverage at any point during the year are more likely than those with no coverage throughout the year to purchase drugs that are needed to control this life-threatening disease. Drug coverage may be provided by Medicare HMOs, individual purchase of private insurance (also called Medigap), employer-sponsored health plans, state pharmaceutical assistance programs, or Medicaid. Blustein's research was supported by a grant from The Commonwealth Fund.

Blustein's findings come from a nationwide survey of Medicare beneficiaries. All individuals included in the analysis were age 65 or older and lived in the community, as opposed to in institutions. All had hypertension—a common problem among older Americans that is a major cause of stroke, heart attack, heart failure, and kidney failure. Blustein found that beneficiaries without coverage were 40 percent more likely than covered beneficiaries to fail to purchase needed antihypertensive medications. Noncovered beneficiaries also faced higher out-of-pocket costs per pill for their drug purchases. Not only did a lack of drug coverage increase the likelihood that an older person would go without antihypertensives, but that lack also decreased the number of tablets purchased annually by those who did buy the medication.

“When patients are financially squeezed they may ‘ration’ their medications or forgo taking them entirely,” says Blustein. “For an older person, this can mean the difference between living a healthy, independent life, and serious disability, or even death.”

Facts and Figures

  • Some of the most vulnerable older Americans with high blood pressure are the least likely to have coverage. Just half (56%) of those with incomes from 100 to 135 percent of the poverty level have drug coverage. In contrast, three-quarters (77%) of those with incomes over 400 percent of the poverty level have coverage.
  • Seniors without coverage must pay more than twice the amount per antihypertensive tablet as those with drug coverage (65 cents vs. 29 cents).

Publication Details



J. Blustein, "Drug Coverage and Drug Purchases by Medicare Beneficiaries with Hypertension," Health Affairs, March/April 2000 19(2):219––30.