Medicare prescription drug benefit progress report: Findings from A 2006 National Survey of Seniors

Health Affairs

Volumn 26, Issue 5, 2007, Pages

  Neuman, Patricia ^a   Strollo, Michelle Kitchman ^b   Guterman, Stuart ^c   Rogers, William H ^d   Li, Angela ^d   Rodday, Angie Mae C ^b   Safran, Dana Gelb ^e,f  

^a HENRY J KAISER FAMILY FOUNDATION   (United States)

^b KFF ^*

^c Program on Medicare's Future   (United States)

^d TUFTS MEDICAL CENTER   (United States)

^e Performance Measurement and Improvement   (United States)

^f TUFTS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; COMPARATIVE STUDY; ECONOMICS; EPIDEMIOLOGY; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH INSURANCE; HUMAN; INFORMATION PROCESSING; INSURANCE; MEDICARE; PATIENT COMPLIANCE; PRESCRIPTION; STATISTICS; UNITED STATES;

AGED; DATA COLLECTION; FINANCING, PERSONAL; HEALTH BENEFIT PLANS, EMPLOYEE; HEALTH CARE SURVEYS; HUMANS; INSURANCE COVERAGE; INSURANCE, PHARMACEUTICAL SERVICES; MEDICARE PART D; PATIENT COMPLIANCE; PRESCRIPTIONS, DRUG; UNITED STATES; UNITED STATES DEPARTMENT OF VETERANS AFFAIRS;

EID: 35148876967     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.5.w630     Document Type: Article

References (33)

1. D.G. Safran et al., "Prescription Drug Coverage and Seniors: Findings from a 2003 National Survey," Health Affairs 24 (2005): w152-w166 (published online 19 April 2005; 10.1377/hlthaff.w5.152);
2. D.G. Safran et al., "Prescription Drug Coverage and Seniors: How Well Are States Closing the Gap?" Health Affairs 21 (2002): w253-w268 (published online 31 July 2002; 10.1377/hlthaff.w2.253);
3. and J.A. Poisal and G.S. Chulis, "Medicare Beneficiaries and Drug Coverage," Health Affairs 19, no. 2 (2000): 248-256.
4. B. Stuart et al., "Riding the Rollercoaster: The Ups and Downs in Out-of-Pocket Spending Under the Standard Medicare Drug Benefit," Health Affairs 24, no. 4 (2005): 1022-1031;
5. H.A. Huskamp and N.L. Keating, "The New Medicare Drug Benefit: Formularies and Their Potential Effects on Access to Medications," Journal of General Internal Medicine 20, no. 7 (2005): 662-665;
6. J. Bowman et al., "Access to Cancer Drugs in Medicare Part D: Formulary Placement and Beneficiary Cost Sharing in 2006," Health Affairs 25, no. 5 (2006): 1240-1248;
7. and W.F. Gellad et al., "How the New Medicare Drug Benefit Could Affect Vulnerable Populations," Health Affairs 25, no. 1 (2006): 248-255.
8. U.S. Department of Health and Human Services, "Over Thirty-eight Million People with Medicare Now Receiving Prescription Drug Coverage," Press Release, 14 June 2006, http://hhs.gov/news/press/2006pres/20060614.html (accessed 7 May 2007);
9. J. Hoadley et al., "An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans," April 2006, http://www.kff.org/medicare/ 7489.cfm (accessed 8 May 2007);
10. F. Heiss et al., "Who Failed to Enroll in Medicare Part D, and Why? Early Results," Health Affairs 25 (2006): w344-w354 (published online 1 August 2006; 10.1377/hlthaff.25.w344);
11. Medicare Payment Advisory Commission, "Update on Medicare Private Plans," chap. 4 in Report to the Congress, Medicare Payment Policy (Washington: MedPAC, March 2007);
12. and Henry J. Kaiser Family Foundation, "Chartpack: Seniors' Early Experiences With Their New Medicare Drug Plans," July 2006, http://www.kff.org/kaiserpolls/upload/7546.pdf (accessed 19 July 2007).
13. For a description of the 2003 survey, see Safran et al., "Prescription Drug Coverage and Seniors."
14. The sample includes approximately 2,200 seniors from each of the four states targeted for oversampling; the remaining sample was drawn proportionally from the other states and the District of Columbia. Geocoding assigns latitude and longitude to a known address, and coordinates are mapped into census block groups (CBGs), allowing census neighborhood variables to be attached to the beneficiary. CBGs are smaller, more homogeneous units than ZIP code, county, or census tract and thus provide a useful proxy for individual socioeconomic characteristics.
15. D.A. Dillman, Mail and Telephone Surveys: The Total Design Method (New York: John Wiley, 1978).
16. Several of these questions were incorporated in the fall 2004 Medicare Current Beneficiary Survey. See Centers for Medicare and Medicaid Services, "Medicare Current Beneficiary Survey (MCBS): Overview," http://www.cms.hhs.gov/MCBS (accessed 19 July 2007).
17. Respondents were asked to provide monthly income from all sources, including income of spouse, by filling in a blank or checking the box with applicable categorical range for their monthly income, similar to the approach used in the MCBS. Unlike the MCBS, the survey did not ask respondents for pretax income.
18. S.F. Buck, "A Method of Estimation of Missing Values in Multivariate Data Suitable for Use with an Electronic Computer," Journal of the Royal Statistical Society B22, no. 2 (1960): 302-306. Ordinal logistic regression was used to estimate the conditional distribution (predicted probabilities) of the missing data. Missing values were replaced with values having the highest probability among the categories.
19. An alternative way of presenting drug coverage data is presented in the Technical Appendix, which shows how the characteristics of seniors vary by source of drug coverage. The appendix is available online at http://content.healthaffairs.org/cgi/content/full/hlthaff.26.5.w630/DC2.
20. DHHS, "Over Thirty-eight Million People."
21. Multivariate models are available on request from the authors; send e-mail to tneuman@kff.org.
22. Notably, 8.5 percent of people dually enrolled in Medicare and Medicaid in 2005 were without Medicaid in 2006 and reported having no drug coverage in 2006.
23. Drug coverage is defined as being creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard Medicare prescription drug coverage [42 CFR, sec. 423.56(a)].
24. M. Gold, "Premiums and Cost-Sharing Features in Medicare's New Prescription Drug Program, 2006," May 2006, http://www.kff.org/medicare/ 7517.cfm (accessed 7 March 2007).
25. These findings were confirmed in multivariate analysis. Dually eligible seniors had a greater likelihood of being subject to prior authorization requirements than other Part D enrollees, after demographic characteristics, health measures, and number of medications were controlled for.
26. E. Heaton, T. Carino, and H. Dix, "Assessing Medicare Prescription Drug Plans in Four States: Balancing Cost and Access," Issue Brief, August 2006, http://www.commonwealthfund.org/publications/publications_show.htm?doc_id= 398836 (accessed 19 July 2007).
27. J. Cubanski and P. Neuman, "Status Report on Medicare Part D Enrollment in 2006: Analysis of Plan-Specific Market Share and Coverage," Health Affairs 26, no. 1 (2007): w1-w12 (published online 21 November 2006; 10.1377/hlthaff.26.1.w1).
28. Government Accountability Office, "Medicare Part D Low-Income Subsidy, Progress Made in Approving Applications, but Ability to Identify Remaining Individuals Is Limited," Testimony of Barbara Bovbjerg before the Senate Committee on Finance, 8 May 2007.
29. See, for example, B. Stuart et al., "Coverage and Use of Prescription Drugs in Nursing Homes: Implications for the Medicare Modernization Act," Medical Care 44, no. 3 (2006): 243-249; and
30. B. Breisacher et al., "Medicare's Disabled Beneficiaries: The Forgotten Population in the Debate over Drug Benefits," September 2002, http://www.kff.org/medicare/6054-index.cfm accessed 19 July 2007).
31. People who are ineligible for low-income subsidies on the basis of assets are thought to be similar in need to those who qualify. See L. Summer and R. Friedland, The Role for the Asset Test in Targeting Benefits for Medicare Savings Programs, October 2002, http://www.commonwealthfund.org/ publications/publications_show.htm?doc_id=221324 (accessed 12 July 2007);
32. and L. Summer, P. Nemore, and J. Finberg, Improving the Medicare Part D Program for the Most Vulnerable Beneficiaries, May 2007, http://www.commonwealthfund.org/publications/publications_show.htm?doc_id= 484282 (accessed 12 July 2007).
33. See, for example, D. Goldman and J.P. Smith, "Methodological Biases in Estimating the Burden of Out-of-Pocket Expenses," Health Services Research 35, no. 6 (2001): 1357-1365.