The Demise of Oregon's Medically Needy Program: Effects of Losing Prescription Drug Coverage and Pharmaceutical Company Drug Assistance Programs Judy Zerzan, MD, MPH Oregon Health & Science University Funded by a RWJ State Coverage Initiatives Grant Office of Oregon Health Policy and Research

Medically Needy Program Optional federally-matched Medicaid program 34 states offer Coverage for people with high medical expenses not qualified for Medicaid Eligibility determined by: –Net monthly income after medical expenses –State established income limit Oregon $413

Oregons Medically Needy Program Covered 8,750 people –69% adults ages with disabilities –31% adults over 65 Covered: –Prescription drugs –Limited mental health services –Limited medical transportation Program terminated Jan. 31, 2003 State policymakers interested in impact

Objectives Conducted 6 months after program end Describe population and use of prescription drugs Investigate changes –Health status –Financial impact –ER visits and hospitalizations

Methods Developed and piloted 49-item survey Phone survey conducted in August 2003 (6 months after end of program) Random state-wide sample of 1,269 –725 wrong numbers and non-contacts –439 respondents –105 refusals –Adequately powered to detect difference in utilization

Characteristics of Participants 64% women Average age 58 years (range 22-91) Predominantly white (92%) 95% unemployed 85% gross income levels <$15,000 per year (2002)

Health Insurance 92% covered by Medicare 21% covered by other health insurance 4.6% had prescription drug benefits

Current Overall Health

Chronic Medical Problems Average 3.5 Chronic Medical Conditions (Range 0-25) Disease% Reporting Hypertension 59% Asthma31% Diabetes 28% Arthritis20% Depression19% Back or neck conditions 17% Heart attack 15% High cholesterol12% Bipolar mood disorder9% Schizophrenia8%

Most Commonly Used Drug Classes Average 5.5 prescriptions per month (Range 0-27) Drug Classes% Reporting Antidepressants53% Narcotics26% Anti-psychotics26% Oral hypoglycemics25% Anxiolytics25% Statins25% ACE inhibitors24% Beta-blockers21% Diuretics20% Thyroid19%

Primary Method of Payment for Prescriptions Before After 100% Medically Needy Program Drug Company Assist Program 29%

Average Monthly Out-of-Pocket Drug Costs Average monthly out-of-pocket costs $ Average drug costs $ / year Average income $ / year Spend 24-48% of income on rx drugs At time of survey 49% skipping drugs

Percentage Not Filling a Prescription by Monthly Out-of-Pocket Prescription Expenses (6 months)

Financial Impact (6 months) To pay for medications: 60% cut back on their food budget 49% skipped paying bills or paid bills late 48% borrowed money from family/friends 21% added credit card debt

Health Status Compared to One Year Ago

Healthcare Utilization 6 months before/after end of MN program (self-report) Total Number p=0.04

Drug Company Patient Assistance Programs 45% currently use 68% get assistance filling out paperwork –primarily from a doctors office or clinic 55% report using these programs is very or somewhat hard to do

Drug Company Patient Assistance Programs (45% use) 37% get only some of their drugs –Mostly not all of their medications are covered 39% of people are very or somewhat confident they can continue to use 52% are not very or not at all confident

NOT Using Drug Company Assistance Programs (55%) 2/3 applied for these programs in the past –41% approved in the past –29% waiting to hear –6% refused –8% didnt finish the paperwork 1/3 who have not applied give the following reasons: –dont know much about –can afford some prescriptions –too much hassle –need assistance with the paperwork –arent available of the drugs they need

Limitations Descriptive study Sample bias –English –Telephone households –Non-responders and wrong numbers Recall bias due to self-reported data Did not capture complexity of all impact on medication use Did not include long-term health outcomes

Conclusions: Loss of Medically Needy Program Oregonians affected: –Unemployed, income under $15,000/yr adults –92% covered by Medicare –Average of 3.5 chronic medical problems –Average of 5.5 prescription drugs a month Found: –Patients taking less of their medications –Financial impact in the daily life of patients –Worsening health status –No increase in ER visits and hospitalizations –Pharmaceutical company assistance programs are not enough

Discussion No increase in ER visits and hospitalizations –6 months too soon Types of diseases Spreading out medication use –Raw data shows may be less surgeries –Selection bias: did not contact sicker –Avoiding further financial impact

Implications Medically Needy population is vulnerable and at risk of further worsening of health Losing drug benefits has immediate impact on drug use and finances National changes –Medically Needy programs –Medicaid funding and benefits Medicare Rx benefit Pharmaceutical company drug assistance programs do not fill the gap Need longer term study

Thanks to: Tina Edlund, Lisa Krois and Jeanene Smith from Office for Oregon Health Policy and Research Dan Touchette and Dean Haxby from OHSU