Purpose: As cost is a critical barrier to medication access among transplant recipients, Medicare Part D represents a key strategy in medication acquisition. Due to number of medications prescribed and expense involved, it is a common assumption that transplant recipients who qualify should be enrolled in Part D. However, no published studies have explored use of Part D in this patient population. Objectives of this study were to examine Part D utilization in a population of low income transplant recipients and determine patient characteristics associated with Part D enrollment.

Methods: A review of records of all patients enrolled in the Medication Access Program (non-profit organization which helps transplant recipients increase access to medications) was conducted. Data collected: Medicare status, Part D enrollment , enrollment in pharmaceutical manufacturers' drug assistance programs (PDAPs) and/or other assistance programs, age, annual income, gender, race, number of medications prescribed, type of transplant, and years since transplant. Chi-square analyses and independent samples t-tests were conducted. Point-biserial correlations and phi coefficients were calculated to assess associations between Part D enrollment and study variables. Stepwise logistic regression was conducted to determine the value of study variables as predictors of Part D enrollment.

Results: 326 transplant recipients were included, all of whom were enrolled in Medicare Parts A and B. The majority were African-American (56.7%), male (56.4%), and enrolled in Part D (58.9%). Part D enrollees compared to non-enrollees were less likely to be enrolled in PDAPs (chi square =57.876, p<0.001), were significantly older (57.5 ± 11.8 vs. 48.0 ± 14.2; p<0.001), had significantly higher incomes ($34,339.42 ± 13,711.67 vs. $31,041.84 ± 15,088.92; p=0.045), and were prescribed a significantly greater number of medications (11.5 ± 1.9 vs. 10.8 ± 2.5; p=0.008). Part D enrollment was correlated to income (r_pb=0.113; p=0.041), number of prescribed medications (r_pb=0.155; p=0.005), age (r_pb=0.342; p<0.001), and PDAP enrollment (phi= -0.421; p<0.001). In the regression model, age, PDAP enrollment, and number of prescription medications were significant predictors of Part D enrollment (p<0.001).

Conclusions: Less than 60% of transplant recipients in a low income population enrolled in Part D. Advantages and disadvantages of Part D, as well as identifying patient groups most likely to benefit from Part D versus other medication assistance programs, will be discussed.

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