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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.

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

1 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

2 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

3 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?

4 Prescription Drug Coverage of Non-Institutionalized Seniors

5 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, 2006. 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.

6 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.

7 Lack of Any Drug Coverage Among Seniors with Selected Characteristics, 2006 Total White African American Non-White Hispanic 100% 101-150% 151-200% >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.

8 Prescription Drug Use, Out-of-Pocket Spending, and Non-Adherence

9 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. 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 2.31.81.7 Spent >$300 in the Last 30 Days 2.02.33.3 Did Not Fill/Delayed Fill or Refill Due to Cost in the Past 12 Months 1.42.21.6 Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-Adherence, 2006 (Odds Ratios)

10 The Part D Low-Income Subsidy (LIS)

11 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

12 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, 2006. (Among Seniors Taking 1 or More Rx)

13 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, 2006. 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

14 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 135% - 150% 101% - 134% 100% Non-White Hispanic African American White % Poverty Race/Ethnicity 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.

15 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.

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