Medication and non-adherence in the older adult.

Ms. D, a 65-year-old woman with hypertension and diabetes, presented to your office for a routine appointment. Her most recent hemoglobin A1C was 9.0. On examination, her vital signs were normal with the exception of blood pressure which was 165/85. Her medications included zestoretic and pioglitazone. On questioning, she revealed that she has not been able to buy her medications because they are too expensive: she had reached the ‘donut hole’ in her prescription coverage plan.