Seniors With Drug Coverage Significantly Increased Under Medicare Part D

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The Medicare prescription drug benefit has significantly increasedthe share of seniors with drug coverage, but one in five beneficiariesreported delaying or not filling prescriptions because of cost,according to the results of a survey published online Tuesday in thejournal Health Affairs, the Los Angeles Times reports. The survey -- conducted in October 2006 by the Kaiser Family Foundation, the Commonwealth Fund and Tufts-New England Medical Center -- included more than 16,000 seniors (Alonso-Zaldivar, Los Angeles Times, 8/21).

Accordingto the study, the percentage of seniors without prescription drugcoverage dropped from 33% in 2005 before the benefit took effect to 8%in 2006 (Ross, Cox/Longview News-Journal,8/21). Overall, about half of all seniors were enrolled in the drugbenefit at the time of the survey, 31% received drug benefits from aformer employer and 3% were covered through the Department of Veterans Affairs.The survey found that about one-quarter of seniors enrolled in theMedicare drug benefit said they had switched to lower-cost genericdrugs, and more were using mail-ordering programs for 90-day suppliesof drugs at a lower cost.

Twenty percent of Medicare drug planbeneficiaries said they did not fill or delayed filling a prescriptionbecause of cost, compared with 23% of those without drug coverage, 8%of those with employer-based benefits and 12% of seniors with coveragethrough the VA (Los Angeles Times, 8/21). About one infour Medicare drug plan beneficiaries said they spent more than $100 inout-of-pocket drug costs per month, and 8% said they spent more than$300 per month, according to the survey. This compares with 11% ofthose without drug coverage and 5% of VA beneficiaries and thoseenrolled in employer-sponsored plans who said they spent more than $300per month, the survey found (Cox/Longview News-Journal, 8/21).

According to the Times,some of the higher costs for Medicare drug plan beneficiaries appear tobe because of the so-called "doughnut hole" coverage gap, under whichbeneficiaries are responsible for 100% of total prescription drug costsbetween $2,400 and $5,450 (Los Angeles Times, 8/21). Otherstudies estimate that 3.4 million to 4.7 million beneficiaries areeligible for but do not receive low-income subsidies that would closethe coverage gap. The survey found that about half of low-incomeseniors not receiving these subsidies were aware of their availability (Cox/Longview News-Journal, 8/21).

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Lead study author Tricia Neuman, vice president of the Kaiser Family Foundation and director of the Foundation's Medicare Policy Project,said, "I was somewhat surprised to see the disparities between[Medicare] plans, and employer and VA coverage. When you control forhealth status, income and other differences, the strong finding thatemployer plans provide better coverage than Medicare comes through loudand clear" (Los Angeles Times, 8/21). According to Neuman,"Low-income subsidies really make a difference for those seniors whoreceive them, but there are still millions of low-income seniors whoare eligible for this help but are not getting it. Our study confirmsthe importance of doing more to get additional assistance to low-incomeseniors" (Cox/Longview News-Journal, 8/21).

KaiserFamily Foundation President and CEO Drew Altman said, "The Medicaredrug law achieved its primary goal of providing drug coverage to mostseniors who previously lacked it," adding, "But the survey found asignificant number of seniors in Part D plans paying sizable amountsout of pocket for their medications and delaying or not filling theirprescriptions for cost reasons."

Commonwealth Fund PresidentKaren Davis said, "In addition to covering more seniors, it's importantthat coverage be adequate to ensure financial protection and access toprescription drugs," said, adding, "We still have a lot of work to doto make sure that Medicare beneficiaries -- particularly those who aremost vulnerable because of low incomes or chronic illness -- can getthe drugs they need and are not subject to burdensome out-of-pocketcosts."

Rep. Pete Stark (D-Calif.) said the drug benefit is "asystem basically designed to create profits for private insuranceplans. I don't want to see it repealed, but I want to see it repaired."CMS officials had no comment on the report (Los Angeles Times, 8/21).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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