ABSTRACT:We surveyed a random sample of 1,500 elderly people with chronic diseases who were enrolled in eight Medicare+Choice plans with a zero-premium, $200-$300 annual drug benefit and no deductible. An estimated 32 percent did not fill a prescription or reduced a prescribed dosage because of out-of-pocket costs. Lower drug benefits, higher out-of-pocket costs, lower income, and poorer health were associated with underuse of medications. Drug benefits with high out-of-pocket costs might not be effective for beneficiaries who use medications for chronic diseases, especially those with low incomes.
Co nc e r n s t h at m an y m e di c a r e b e n e f i c i a r i e s cannot afford essential prescription medications prompted proposals for a nationwide outpatient Medicare drug benefit.1 An effective drug benefit would greatly reduce or eliminate cost-related compromises in the use of prescribed medications. Studies have suggested that the effectiveness of drug benefits varies with the extent of coverage.2 Evaluations of defined drug benefits are needed to help formulate a Medicare drug benefit that is effective, given limited resources. We evaluated supplemental drug benefits provided by several Medicare+Choice (M+C) health plans in 2002 by estimating how frequently Medicare beneficiaries with chronic diseases did not use medications as prescribed because of their out-ofpocket costs. Furthermore, the study sought to identify ways health care professionals might determine the likelihood that patients will compromise their use of prescribed medications because of out-of-pocket costs.
Study Data And Methodsn Population. Medicare beneficiaries enrolled in M+C plans in eight metropolitan areas in five states in the South, Midwest, and Northeast participated in this in- Thomas Rector (Thomas.Rector@med. va.gov vestigation. These plans offered a supplemental drug benefit ranging from $200 to $300 per year. Retail prescription copayments ranged from $5 to $12 for generic medications and from $35 to $75 for brand-name medications. Beneficiaries did not pay for premiums or deductibles out of pocket.A key test of a Medicare drug benefit is whether it fosters effective drug use by chronically ill beneficiaries.3 Therefore, the sampling frame was restricted to enrollees that had at least one claim for a physician visit or hospital stay that listed an International Classification of Diseases (ICD) code for hypertension (401.xx-405.xx), hyperlipidemia (272.0, 272.2), ischemic heart disease (410.xx-413.xx, 414, 414.0x, 414.8x, 414.9x), congestive heart failure (428.xx), non-insulin dependent diabetes (250.x0, 250.x2), arthritis (714.xx, 715.xx), glaucoma (365.1x, 365.2x, 365.9), or gastrointestinal ulcers (531.xx to 534.xx). Drug claims were not used to define the study population, since those who did not fill prescriptions because of out-of-pocket costs might be missed.One of the limitations of this study was the exclusion of the 9 percent of beneficiaries who were not continuously enrolled during the first six months of 2002. ...
