Do drug benefits help medicare beneficiaries afford prescribed drugs?

Health Affairs

Volumn 23, Issue 4, 2004, Pages 213-222

  Rector, Thomas S ^a   Venus, Patricia J ^b  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

^b Center for Health Care Policy and Evaluation   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; CHRONIC DISEASE; CONTROLLED STUDY; DRUG COST; FEMALE; HEALTH STATUS; HUMAN; LOWEST INCOME GROUP; MAJOR CLINICAL STUDY; MALE; MEDICARE; PRESCRIPTION; RANDOMIZATION; REVIEW;

AGED; COST CONTROL; DRUG COSTS; FEES AND CHARGES; FEMALE; FINANCING, PERSONAL; HUMANS; INSURANCE, PHARMACEUTICAL SERVICES; MALE; MEDICARE PART C; UNITED STATES;

EID: 3242668119     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.4.213     Document Type: Review

References (34)

1. See, for example, S.B. Soumerai and D. Ross-Degnan, "Inadequate Prescription Drug Coverage for Medicare Enrollees - A Call to Action," New England Journal of Medicine 340, no. 9 (1999): 722-728; J.A. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries With and Without Drug Coverage," Health Affairs 20, no. 2 (2001): 74-85; and A.S. Adams, S.B. Soumerai, and D. Ross-Degnan, "The Case for a Medicare Drug Coverage Benefit: A Critical Review of the Empirical Evidence," Annual Review of Public Health 22 (2001): 49-61.
2. See, for example, S.B. Soumerai and D. Ross-Degnan, "Inadequate Prescription Drug Coverage for Medicare Enrollees - A Call to Action," New England Journal of Medicine 340, no. 9 (1999): 722-728; J.A. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries With and Without Drug Coverage," Health Affairs 20, no. 2 (2001): 74-85; and A.S. Adams, S.B. Soumerai, and D. Ross-Degnan, "The Case for a Medicare Drug Coverage Benefit: A Critical Review of the Empirical Evidence," Annual Review of Public Health 22 (2001): 49-61.
3. See, for example, S.B. Soumerai and D. Ross-Degnan, "Inadequate Prescription Drug Coverage for Medicare Enrollees - A Call to Action," New England Journal of Medicine 340, no. 9 (1999): 722-728; J.A. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries With and Without Drug Coverage," Health Affairs 20, no. 2 (2001): 74-85; and A.S. Adams, S.B. Soumerai, and D. Ross-Degnan, "The Case for a Medicare Drug Coverage Benefit: A Critical Review of the Empirical Evidence," Annual Review of Public Health 22 (2001): 49-61.
4. See, for example, D.G. Safran et al., "Prescription Drug Coverage and Seniors: How Well Are States Closing the Gap?" Health Affairs, 31 July 2002, content.healthaffairs.org/cgi/content/abstract/hlthaff.w2.253 (20 April 2004); M.A. Steinman, L.P. Sands, and K.E. Covinsky, "Self-Restriction of Medications Due to Cost in Seniors without Prescription Coverage, A National Survey," Journal of General Internal Medicine 16, no. 12 (2001): 793-799; D.A. Taira, K.A. Iwane, and R.S. Chung, "Prescription Drugs: Elderly Enrollee Reports of Financial Access, Receipt of Free Samples, and Discussion of Generic Equivalents Related to Type of Coverage," American Journal of Managed Care 9, no. 4 (2003): 305-312; and R. Mojtabai and M. Olfson, "Medication Costs, Adherence, and Health Outcomes among Medicare Beneficiaries," Health Affairs 22, no. 4 (2003): 220-229.
5. See, for example, D.G. Safran et al., "Prescription Drug Coverage and Seniors: How Well Are States Closing the Gap?" Health Affairs, 31 July 2002, content.healthaffairs.org/cgi/content/abstract/hlthaff.w2.253 (20 April 2004); M.A. Steinman, L.P. Sands, and K.E. Covinsky, "Self-Restriction of Medications Due to Cost in Seniors without Prescription Coverage, A National Survey," Journal of General Internal Medicine 16, no. 12 (2001): 793-799; D.A. Taira, K.A. Iwane, and R.S. Chung, "Prescription Drugs: Elderly Enrollee Reports of Financial Access, Receipt of Free Samples, and Discussion of Generic Equivalents Related to Type of Coverage," American Journal of Managed Care 9, no. 4 (2003): 305-312; and R. Mojtabai and M. Olfson, "Medication Costs, Adherence, and Health Outcomes among Medicare Beneficiaries," Health Affairs 22, no. 4 (2003): 220-229.
6. See, for example, D.G. Safran et al., "Prescription Drug Coverage and Seniors: How Well Are States Closing the Gap?" Health Affairs, 31 July 2002, content.healthaffairs.org/cgi/content/abstract/hlthaff.w2.253 (20 April 2004); M.A. Steinman, L.P. Sands, and K.E. Covinsky, "Self-Restriction of Medications Due to Cost in Seniors without Prescription Coverage, A National Survey," Journal of General Internal Medicine 16, no. 12 (2001): 793-799; D.A. Taira, K.A. Iwane, and R.S. Chung, "Prescription Drugs: Elderly Enrollee Reports of Financial Access, Receipt of Free Samples, and Discussion of Generic Equivalents Related to Type of Coverage," American Journal of Managed Care 9, no. 4 (2003): 305-312; and R. Mojtabai and M. Olfson, "Medication Costs, Adherence, and Health Outcomes among Medicare Beneficiaries," Health Affairs 22, no. 4 (2003): 220-229.
7. See, for example, D.G. Safran et al., "Prescription Drug Coverage and Seniors: How Well Are States Closing the Gap?" Health Affairs, 31 July 2002, content.healthaffairs.org/cgi/content/abstract/hlthaff.w2.253 (20 April 2004); M.A. Steinman, L.P. Sands, and K.E. Covinsky, "Self-Restriction of Medications Due to Cost in Seniors without Prescription Coverage, A National Survey," Journal of General Internal Medicine 16, no. 12 (2001): 793-799; D.A. Taira, K.A. Iwane, and R.S. Chung, "Prescription Drugs: Elderly Enrollee Reports of Financial Access, Receipt of Free Samples, and Discussion of Generic Equivalents Related to Type of Coverage," American Journal of Managed Care 9, no. 4 (2003): 305-312; and R. Mojtabai and M. Olfson, "Medication Costs, Adherence, and Health Outcomes among Medicare Beneficiaries," Health Affairs 22, no. 4 (2003): 220-229.
8. Poisal and Murray, "Growing Differences"; Steinman et al., "Self-Restriction of Medications"; E.P. Steinberg et al., "Beyond Survey Data: A Claims-Based Analysis of Drug Use and Spending by the Elderly," Health Affairs 19, no. 2 (2000): 198-211; and W. Hwang et al., "Out-of-Pocket Medical Spending for Care of Chronic Conditions," Health Affairs 20, no. 6 (2001): 267-278.
9. Poisal and Murray, "Growing Differences"; Steinman et al., "Self-Restriction of Medications"; E.P. Steinberg et al., "Beyond Survey Data: A Claims-Based Analysis of Drug Use and Spending by the Elderly," Health Affairs 19, no. 2 (2000): 198-211; and W. Hwang et al., "Out-of-Pocket Medical Spending for Care of Chronic Conditions," Health Affairs 20, no. 6 (2001): 267-278.
10. Poisal and Murray, "Growing Differences"; Steinman et al., "Self-Restriction of Medications"; E.P. Steinberg et al., "Beyond Survey Data: A Claims-Based Analysis of Drug Use and Spending by the Elderly," Health Affairs 19, no. 2 (2000): 198-211; and W. Hwang et al., "Out-of-Pocket Medical Spending for Care of Chronic Conditions," Health Affairs 20, no. 6 (2001): 267-278.
11. Poisal and Murray, "Growing Differences"; Steinman et al., "Self-Restriction of Medications"; E.P. Steinberg et al., "Beyond Survey Data: A Claims-Based Analysis of Drug Use and Spending by the Elderly," Health Affairs 19, no. 2 (2000): 198-211; and W. Hwang et al., "Out-of-Pocket Medical Spending for Care of Chronic Conditions," Health Affairs 20, no. 6 (2001): 267-278.
12. T.S. Rector, "Exhaustion of Drug Benefits and Disenrollment of Medicare Beneficiaries from Managed Care Organizations," Journal of the American Medical Association 283, no. 16 (2000): 2163-2167.
13. "Different" refers to prescriptions for medications that contain different active ingredients rather than repeated use of the same prescription or use of different formulations of the same active ingredient(s). A copy of the complete questionnaire is available from Tom Rector, Thomas.Rector@med.va.gov.
14. M.L. Berk, C.L. Schur, and P. Mohr, "Using Survey Data to Estimate Prescription Drug Costs," Health Affairs 9, no. 3 (1990): 146-156; and S.B. Cohen and V.L. Burt, "Data Collection Frequency Effect in the National Medical Care Expenditure Survey," Journal of Economic and Social Measurement 13, no. 2 (1985): 125-151.
15. M.L. Berk, C.L. Schur, and P. Mohr, "Using Survey Data to Estimate Prescription Drug Costs," Health Affairs 9, no. 3 (1990): 146-156; and S.B. Cohen and V.L. Burt, "Data Collection Frequency Effect in the National Medical Care Expenditure Survey," Journal of Economic and Social Measurement 13, no. 2 (1985): 125-151.
16. D.B. Rubin, "Multiple Imputation after Eighteen-Plus Years," Journal of the American Statistical Association 91, no. 434 (1996): 473-489; J.L. Schafer and J.W. Graham, "Missing Data: Our View of the State of the Art," Psychological Methods 7, no. 2 (2002): 147-177; and T.E. Raghunathan et al., "A Multivariate Technique for Multiply Imputing Missing Values using a Sequence of Regression Models," Survey Methodology 27, no. 1 (2001): 85-95.
17. D.B. Rubin, "Multiple Imputation after Eighteen-Plus Years," Journal of the American Statistical Association 91, no. 434 (1996): 473-489; J.L. Schafer and J.W. Graham, "Missing Data: Our View of the State of the Art," Psychological Methods 7, no. 2 (2002): 147-177; and T.E. Raghunathan et al., "A Multivariate Technique for Multiply Imputing Missing Values using a Sequence of Regression Models," Survey Methodology 27, no. 1 (2001): 85-95.
18. D.B. Rubin, "Multiple Imputation after Eighteen-Plus Years," Journal of the American Statistical Association 91, no. 434 (1996): 473-489; J.L. Schafer and J.W. Graham, "Missing Data: Our View of the State of the Art," Psychological Methods 7, no. 2 (2002): 147-177; and T.E. Raghunathan et al., "A Multivariate Technique for Multiply Imputing Missing Values using a Sequence of Regression Models," Survey Methodology 27, no. 1 (2001): 85-95.
19. Henry J. Kaiser Family Foundation, Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, 10 December 2003, www.kff.org/medicare/ 6112.cfm (8 January 2004).
20. D.M. Walker, Medicare: Observations on Program Sustainability and Strategies to Control Spending on any Proposed Drug Benefit, Pub. no. GAO-03-650T (Washington: U.S. General Accounting Office, April 2003).
21. DHHS, Report to the President; and B.M. Craig, D.H. Kreling, and D.A. Mott, "Do Seniors Get the Medicines Prescribed for Them? Evidence from the 1996-1999 Medicare Current Beneficiary Survey," Health Affairs 22, no. 3 (2003): 175-182.
22. DHHS, Report to the President; and B.M. Craig, D.H. Kreling, and D.A. Mott, "Do Seniors Get the Medicines Prescribed for Them? Evidence from the 1996-1999 Medicare Current Beneficiary Survey," Health Affairs 22, no. 3 (2003): 175-182.
23. E.R. Cox and R.R. Henderson, "Prescription Use Behavior among Medicare Beneficiaries with Capped Prescription Benefits," American Journal of Managed Care 8, no. 5 (2002): 360-364; and E.R. Cox et al., "Medicare Beneficiaries' Management of Capped Prescription Benefits," Medical Care 39, no. 3 (2001): 296-301.
24. E.R. Cox and R.R. Henderson, "Prescription Use Behavior among Medicare Beneficiaries with Capped Prescription Benefits," American Journal of Managed Care 8, no. 5 (2002): 360-364; and E.R. Cox et al., "Medicare Beneficiaries' Management of Capped Prescription Benefits," Medical Care 39, no. 3 (2001): 296-301.
25. See, for example, N. Col, J.E. Fanale, and P. Kronholm, "The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine 150, no. 4 (1990): 841-845; S.D. Sullivan, D.H. Kreling, and T.K. Hazlet, "Noncompliance with Medication Regimens and Subsequent Hospitalizations: A Literature Analysis and Cost of Hospitalization Estimate," Journal of Research in Pharmacy and Economics 2, no. 1 (1990): 19-33; J. Kennedy and J.C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124; R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429; S.B. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; and S.B. Soumerai et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine 331, no. 10 (1994): 650-655.
26. See, for example, N. Col, J.E. Fanale, and P. Kronholm, "The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine 150, no. 4 (1990): 841-845; S.D. Sullivan, D.H. Kreling, and T.K. Hazlet, "Noncompliance with Medication Regimens and Subsequent Hospitalizations: A Literature Analysis and Cost of Hospitalization Estimate," Journal of Research in Pharmacy and Economics 2, no. 1 (1990): 19-33; J. Kennedy and J.C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124; R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429; S.B. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; and S.B. Soumerai et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine 331, no. 10 (1994): 650-655.
27. See, for example, N. Col, J.E. Fanale, and P. Kronholm, "The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine 150, no. 4 (1990): 841-845; S.D. Sullivan, D.H. Kreling, and T.K. Hazlet, "Noncompliance with Medication Regimens and Subsequent Hospitalizations: A Literature Analysis and Cost of Hospitalization Estimate," Journal of Research in Pharmacy and Economics 2, no. 1 (1990): 19-33; J. Kennedy and J.C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124; R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429; S.B. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; and S.B. Soumerai et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine 331, no. 10 (1994): 650-655.
28. See, for example, N. Col, J.E. Fanale, and P. Kronholm, "The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine 150, no. 4 (1990): 841-845; S.D. Sullivan, D.H. Kreling, and T.K. Hazlet, "Noncompliance with Medication Regimens and Subsequent Hospitalizations: A Literature Analysis and Cost of Hospitalization Estimate," Journal of Research in Pharmacy and Economics 2, no. 1 (1990): 19-33; J. Kennedy and J.C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124; R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429; S.B. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; and S.B. Soumerai et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine 331, no. 10 (1994): 650-655.
29. See, for example, N. Col, J.E. Fanale, and P. Kronholm, "The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine 150, no. 4 (1990): 841-845; S.D. Sullivan, D.H. Kreling, and T.K. Hazlet, "Noncompliance with Medication Regimens and Subsequent Hospitalizations: A Literature Analysis and Cost of Hospitalization Estimate," Journal of Research in Pharmacy and Economics 2, no. 1 (1990): 19-33; J. Kennedy and J.C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124; R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429; S.B. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; and S.B. Soumerai et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine 331, no. 10 (1994): 650-655.
30. See, for example, N. Col, J.E. Fanale, and P. Kronholm, "The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine 150, no. 4 (1990): 841-845; S.D. Sullivan, D.H. Kreling, and T.K. Hazlet, "Noncompliance with Medication Regimens and Subsequent Hospitalizations: A Literature Analysis and Cost of Hospitalization Estimate," Journal of Research in Pharmacy and Economics 2, no. 1 (1990): 19-33; J. Kennedy and J.C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124; R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429; S.B. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; and S.B. Soumerai et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine 331, no. 10 (1994): 650-655.
31. See, for example, N. Col, J.E. Fanale, and P. Kronholm, "The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly," Archives of Internal Medicine 150, no. 4 (1990): 841-845; S.D. Sullivan, D.H. Kreling, and T.K. Hazlet, "Noncompliance with Medication Regimens and Subsequent Hospitalizations: A Literature Analysis and Cost of Hospitalization Estimate," Journal of Research in Pharmacy and Economics 2, no. 1 (1990): 19-33; J. Kennedy and J.C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124; R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429; S.B. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; and S.B. Soumerai et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine 331, no. 10 (1994): 650-655.
32. G.C. Alexander, L.P. Casalino, and D.O. Meltzer, "Patient-Physician Communication about Out-of-Pocket Costs," Journal of the American Medical Association 290, no. 7 (2003): 953-958; and L.M. Korn et al., "Improving Physicians' Knowledge of the Costs of Common Medications and Willingness to Consider Costs When Prescribing," Journal of General Internal Medicine 18, no. 1 (2003): 31-37.
33. G.C. Alexander, L.P. Casalino, and D.O. Meltzer, "Patient-Physician Communication about Out-of-Pocket Costs," Journal of the American Medical Association 290, no. 7 (2003): 953-958; and L.M. Korn et al., "Improving Physicians' Knowledge of the Costs of Common Medications and Willingness to Consider Costs When Prescribing," Journal of General Internal Medicine 18, no. 1 (2003): 31-37.
34. M.D. Schoen et al., "Impact of the Cost of Prescription Drugs on Clinical Outcomes in Indigent Patients with Heart Disease," Pharmacothcrapy 21, no. 12 (2001): 1455-1463.