Do Drug Benefits Help Medicare Beneficiaries Afford Prescribed Drugs?

Abstract

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. ...

Association of Out-of-Pocket Pharmacy Costs with Adherence to Varenicline

“…In response to cost-related concerns, individuals may skip doses, take smaller doses to prolong medication coverage, shift spending from other basic needs to cover prescription costs, or simply not fill necessary prescriptions. 10,17 Our results show that greater varenicline OOP expense is associated with lower treatment episode. In the COMPASS trial, Catz et al (2011) found that over half of the patients (52.2%) who took ≥ 80% of the prescribed varenicline regimen were abstinent at the 6-month follow-up, compared with 25.4% who took less than 80% of the days prescribed.…”

Estudo de base populacional da subutilização de medicamentos por motivos financeiros entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

“…De fato, estudos apontam para associações entre subutilização de medicamentos por motivos financeiros e renda mais baixa 8,9,10 , ser não branco 8,10,11,12 , pior condição de saúde e presença de co-morbidades 8,9,11,12 . Adicionalmente, existem evidências de que a subutilização de medicamentos por motivos financeiros é menor entre idosos filiados a plano de saúde 12 , entre aqueles com menores gastos mensais com medicamentos 8,9,10 ou que têm cobertura para obtenção dos mesmos 8,9,11,12 , assim como entre aqueles que avaliam melhor a qualidade da assistência médica recebida 13,14 .…”

Examination of Multiple Medication Use Among TRICARE Beneficiaries Aged 65 Years and Older

“…TRICARE does not impose premiums, enrollment fees, benefit caps, or plan-wide deductibles that increase the patient' s cost burden beyond the point-of-service copayment amount, or otherwise promote periods of potential noncoverage. 15,16 Beneficiaries could use their prescription drug benefit without using any other health care services offered under TRICARE, and TRICARE was a secondary payer if other health insurance was used to purchase prescription medication. 17 The purpose of the current research was to quantify and characterize multiple medication use among the DoD beneficiaries aged 65 years and older with the ultimate goal of assessing the need for additional interventions to mitigate risks posed to older adults by the growing role of pharmacotherapy in their treatment regimen.…”