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This report presents the findings from a survey on Medicare Part D prescription drug benefit, including enrollment rates, out-of-pocket costs, and experiences of seniors. It also examines the impact of the low-income subsidy on spending and adherence.
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Medicare Prescription Drug Benefit Progress Report: Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors and Prescription Drugs Stuart Guterman Director, Program on Medicare’s Future The Commonwealth Fund Alliance for Health Reform Briefing: Medicare Part D: What Now, What Next? Washington, DC November 5, 2007
Survey of Medicare Beneficiaries, 2006 • Mail survey with telephone follow-up conducted between October 5 and December 20, 2006 • Participants were administered one of 3 versions of the survey in English or Spanish in accordance with CMS-designated enrollment status: • Dual Eligibles • Medicare Advantage enrollees • All others • Analysis examined drug coverage, use, out-of-pocket costs, adherence, and experiences in a Part D plan • To provide an in-depth look at how seniors fared after implementation of the Medicare drug benefit • Study used an augmented longitudinal design including respondents to our 2003 national survey of seniors and a random, nationally representative sample of non-institutionalized seniors provided by CMS in June 2006 • Sample included more than 16,000 non-institutionalized Medicare beneficiaries age 65 and older (response rate of 56%)
Key Questions Addressed • What share of seniors were enrolled in Part D plans in 2006; What were their characteristics and the characteristics of those who remained without coverage? • How did out-of-pocket prescription drug spending and cost-related non-adherence compare for Part D enrollees and seniors with other sources of coverage? • How did the characteristics and experiences of seniors in Part D plans differ across stand-alone drug plans and Medicare Advantage drug plans? • To what extent did the Part D low-income subsidy affect out-of-pocket spending and cost-related non-adherence? • What were the experiences of dual eligibles after enrolling in Part D plans?
Distribution of Seniors’ Drug Coverage in 2006Among Those Who Did Not Have Drug Coverage in 2005 Drug coverage in 2005: Source of Drug Coverage in 2006: No Rx Coverage VA Employer Other Yes No Part D NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Distribution of Seniors by Primary Source of Drug Coverage, 2006 Employer Part D VA None Other Coverage NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Lack of Any Drug Coverage Among Seniors with Selected Characteristics, 2006 Total Urban/Rural Location * Rural Urban Race/Ethnicity White African American * Non-White Hispanic % Poverty * ≤100% 101-150% * 151-200% >200% Chronic Conditions None 1 or 2 * * 3 or more NOTES: Sample excludes institutionalized seniors. Weighted percentages. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Reference groups for statistical significance include: white, >200% poverty, and no chronic conditions (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Prescription Drug Use, Out-of-Pocket Spending, and Non-Adherence
Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-Adherence, 2006 (Odds Ratios) Notes: Sample excludes institutionalized seniors. Findings based on three separate models each of which controlled for demographics, health measures, self-reported diseases, number of duals, and source of coverage. Among seniors taking one or more prescription medications. VA is Department of Veterans Affairs. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Dugs, 2006.
Chart 14 Low-Income Subsidy (LIS) Analysis • Analysis examines the characteristics and experiences of those receiving the LIS in 2006 • Unable to look at participation in the LIS program because a large share of respondents did not know whether they were receiving the LIS • We classified respondents as potentially eligible for LIS if their self-reported income was less than or equal to 150% of poverty; Not able to use self-reported asset data • 25% non-response rate for question about assets • Analysis may over-identify those characterized as potentially eligible for, but not receiving LIS • Dual eligibles were analyzed separately from other LIS recipients to examine their unique characteristics and experiences
Out-of-Pocket Spending on Prescriptions and Non-Adherence Among Low-Income Seniors in Part D Plans, With and Without the Low-Income Subsidy (LIS), 2006 (Among Seniors Taking 1 or More Rx) With LIS (excluding Dual Eligibles) Without LIS NOTES: Sample excludes institutionalized seniors. “Did not fill/delayed filling” refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: with LIS versus without LIS (*p < 0.05). Low-income is defined as at or below 150% of poverty. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Drug Coverage Among Seniors with Incomes At or Below 150% of Poverty Who Were Not Receiving the Low-Income Subsidy (LIS), 2006 No Rx Coverage Nearly half of all seniors at or below 150% of poverty without the low-income subsidy are in a Part D plan Other Part D Employer/ VA NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Share of Seniors With Incomes At or Below 150% of Poverty Who Said That They Were Not Aware of the Part D Low-Income Subsidy (LIS), Among Those Not Receiving The LIS, 2006 % Poverty ≤100% 101% - 134% 135% - 150% Race/Ethnicity White African American Non-White Hispanic NOTES: Sample excludes institutionalized seniors. Weighted percentages. Reference Groups: 135-150% of poverty, white, and Part D Rx Coverage (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Conclusions • Medicare drug benefit reached most seniors who lacked drug coverage in 2005. • Seniors in Part D plans fared better than those who lacked drug coverage in terms of out-of-pocket costs and rates of cost-related non-adherence. • However, Part D plans provided less financial protection against high out-of-pocket spending than either employer plans or the VA. • Survey highlights the beneficial effects of the low-income subsidy for those receiving them and underscores the importance of sustained efforts to increase participation in the LIS program.
