Medicare Prescription Drug Benefit Progress Report: Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors.

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Presentation transcript:

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 Medicares 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 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%) 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

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?

Prescription Drug Coverage of Non-Institutionalized Seniors

Distribution of Seniors Drug Coverage in 2006 Among Those Who Did Not Have Drug Coverage in 2005 Yes No Drug coverage in 2005: SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, Source of Drug Coverage in 2006: No Rx Coverage Other Part D VA Employer NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded.

Part D Employer VA Other Coverage None Distribution of Seniors by Primary Source of Drug Coverage, 2006 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 White African American Non-White Hispanic 100% % % >200% 1 or 2 3 or more None Race/Ethnicity % Poverty Chronic Conditions Rural Urban Urban/Rural Location * * * * * * 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

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, Source of Coverage vs. Reference Group None vs. Part D Part D vs. Employer Part D vs. VA Spent >$100 in the Last 30 Days Spent >$300 in the Last 30 Days Did Not Fill/Delayed Fill or Refill Due to Cost in the Past 12 Months Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-Adherence, 2006 (Odds Ratios)

The Part D Low-Income Subsidy (LIS)

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 Chart 14

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 Without LISWith LIS (excluding Dual Eligibles) 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, (Among Seniors Taking 1 or More Rx)

Drug Coverage Among Seniors with Incomes At or Below 150% of Poverty Who Were Not Receiving the Low- Income Subsidy (LIS), 2006 Part D Employer/ VA Other No Rx Coverage SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. Nearly half of all seniors at or below 150% of poverty without the low-income subsidy are in a Part D plan

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, % - 150% 101% - 134% 100% Non-White Hispanic African American White % Poverty Race/Ethnicity NOTES: Sample excludes institutionalized seniors. Weighted percentages. Reference Groups: % 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 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.