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Medicare Beneficiary Knowledge of, Awareness of, and Experience with Prescription Drug Discount Cards Noemi V. Rudolph, MPH and Sunyna S. Williams, PhD Centers for Medicare & Medicaid Services The opinions presented here are those of the authors and may not represent the views or policies of the Centers for Medicare & Medicaid Services

Acknowledgements • CMS: Brigid Goody, Frank Eppig, Gerald Riley, Gerald Adler • RTI International • Westat: Eileen Horan

Introduction • In anticipation of the Medicare Prescription Drug Coverage Program, we sought to understand beneficiary experiences and knowledge of prescription drug discount cards • Baseline information prior to any Medicare-sponsored card, follow-up one-year later with information about Medicare-approved drug cards

Data • Medicare Current Beneficiary Survey (MCBS) – nationally representative sample of Medicare beneficiaries; continuous, multipurpose, include topical supplements • Questionnaire Item Development - Questions in Discount Awareness (DA) Supplement were developed and cognitively tested; examined perceived and demonstrated knowledge about, sources of information for, experience and satisfaction with their drug discount card(s); questions for MA supplement were derived from DA supplement, but changed as needed to focus on Medicare-approved drug discount cards

Data • Sample: community dwelling, non-institutionalized, proxies allowed DA Supplement – May through August 2004, n=13,344 MA Supplement – May through August 2005, n=10,917; focused questions on MA drug cards, excludes beneficiaries with full Medicaid Linked dataset – capture respondents who were part of both DA and MA supplement, n=7,572

Variables • Demographics and insurance: socio-demographics, health status, Medicare health insurance category, drug coverage • Drug card: perceived drug card knowledge, drug card knowledge score, whether sought information about drug cards, done anything to reduce cost of drugs • Medicare knowledge: understandability of the Medicare program, global perceived Medicare program knowledge, Medicare knowledge quiz, whether make own health decisions

Analyses • Descriptive: weighted percentages of card awareness, information seeking behavior, cost-reduction strategies, card experiences, overall satisfaction, expected savings, reasons for no current card, transitional assistance • Comparisons between cardholders and non-cardholders: general linear model analyses accounting for complex sample design

Analyses (cont) • Predictions of knowledge: simple linear regression to get individual factors associated with DA or MA knowledge, then backward elimination multiple regressions to arrive at the final models

Perceived Knowledge & Information Seeking Behavior • 60% perceived they knew nothing or almost nothing about DA drug cards, 56% for MA drug cards • 16-17% sought information about DA and MA drug cards • Sources of information: pharmacists, Medicare (1-800-MEDICARE, brochures, pamphlet from Medicare), AARP and other senior organizations

Percent of DA and MA Cardholders • 2003: 9% had DA card 2004: 8% had DA card only; 2% had MA card only, 4% had both • In 2004, those who had one type of card were significantly more likely to have the other type of card (32% of DA cardholders compared to 2% of DA non-cardholders were also MA cardholders)

Card Experiences

Card Experiences (cont)

Reasons for not having card

Cost-reduction strategies

DA Cardholders vs. Non-cardholders • DA cardholders more likely to be older seniors, female, white, widowed, lower income, more chronic conditions, have no other drug coverage, more likely to be those with Original Medicare with and without supplement, have greater perceived knowledge about drug cards, more likely to have sought information, have done something to reduce cost of drugs, have higher DA drug card knowledge • No differences: education, perceived health status, understandability of Medicare, perceived Medicare knowledge

MA Cardholders vs. Non-cardholders • Similar findings to DA analysis except: - MA cardholders less likely to be educated, to be married, lower perceived health status, have Original Medicare plus supplement or managed care, more likely to have Original Medicare or dual eligible - No significant differences in age, race • Some of the demographic and insurance differences between DA and MA findings likely due to exclusion of full duals in MA supplement

DA Card Knowledge • Factors associated with higher DA card knowledge: - some college education and beyond - income >$25K - higher perceived health status - current cardholder - higher perceived knowledge about drug cards - tried to find information about drug cards - did something to reduce the cost of drugs - higher score on Medicare knowledge items

DA Card Knowledge • Factors associated with lower levels of knowledge: - age 65 and over - race of Black or Other - female - widowed - never married - Medicare managed care - dual eligible

MA Card Knowledge • Factors associated with higher MA card knowledge: - age 75-84 - some college education - income >$25K - current cardholder - higher perceived knowledge about MA cards - tried to find information about MA cards - did something to reduce the cost of drugs - higher score on Medicare knowledge items

MA Card Knowledge • Factors associated with lower MA card knowledge: - age 85+ - race of Black or Other - have drug coverage - understandability about the Medicare program

TA Subanalyses • Approx. 65% of MA cardholders did not apply for TA • Reasons did not apply - Not/not think eligible 60.5% - Didn’t know how to apply 21.9 - Doesn’t need due to other cov 10.9 - Didn’t understand application info 7.6 - Automatically enrolled by state 5.6 - Not worth the trouble 1.9 - Other 1.7 • Those with TA more satisfied and saved more than expected

Conclusions • Beneficiary perceived knowledge of prescription drug discount cards (general and Medicare-approved) were low and few were interested in more information. • DA/MA cardholders (vs. non-cardholders) more likely to be female, widowed, low income, more chronic conditions, no other drug coverage, greater perceived knowledge, sought information, done something to reduce the cost of drugs, and higher knowledge quiz scores; no differences in perceived health status, making own health decisions, understandability of Medicare and perceived Medicare knowledge

Conclusions • Factors associated with higher card knowledge include college education, income>$25K, cardholder, higher perceived knowledge about drug cards, tried to find info about cards, did something to reduce cost of drugs, and high Medicare quiz score. Factors associated with lower card knowledge include age and race. • Understanding of factors associated with knowledge of, awareness of, and experiences with prescription drug discount cards can help CMS better target their educational efforts for the Medicare Prescription Drug Coverage Program

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