Shepard DS, Leung M, Stason W, Ritter G, Thomas C; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 3641.
Brandeis University, Heller School, MS 035, 415 South Street, Waltham, MA 02454-9110 Tel. 781-736-3975 Fax 781-736-3928
RESEARCH OBJECTIVE: In mid-2002, the states of Illinois and Wisconsin initiated SeniorCare (SC) pharmacy assistance programs (PAPs) that provide low-income persons aged 65+ with publicly funded prescription drug assistance. The programs were designed to help seniors improve prescription drug use, reduce financial hardship due to prescription costs, maintain health, and avoid entry onto full benefit Medicaid. Enrollees generally faced maximum co-payments per prescription of $4 in IL and $15 in WI. Enrollees with incomes up to 200% of the federal poverty limit (FPL) were funded under a Medicaid waiver. A sample of these enrollees was surveyed to assess success of implementation and first-year impact on behaviors. STUDY DESIGN: Through a stratified random sample, an academic survey research organization interviewed 2,227 participants by telephone in spring 2004 (response rate 61%). Key questions contrasted prescription purchase and going without necessities during the 6 months prior to joining SC to the latest 6 months in SC. A respondent who skimped was one who reported not filling all prescribed medications or skipping some doses for financial reasons during one of these time periods. POPULATION STUDIED: To contrast sub-populations, participants were selected from three strata: 68,292 Wisconsin members, who were all new enrollees (1,189 interviewed), 121,000 Illinois members who were previously in a limited PAP that excluded mental health and gastro-intestinal drugs and automatically rolled over into SC (termed 'IL rollovers,' 374 interviewed), and 47,782 Illinois members not previously in this PAP (termed 'IL new,' 664 interviewed). PRINCIPAL FINDINGS: With an average age of 77 years, respondents were mostly female (73%), white (83%), had household incomes below 160% of the FPL (66%), and lived alone (53%). Only 1% of enrollees reported any problems in joining the programs. The proportion of people going without some necessities was cut in half from 35.4% before SC to 17.0% after SC. The overall share of skimping was 28.4% before SC and 12.9% after SC, representing a proportional reduction of 55%. As expected, before SC, IL rollovers were significantly less likely to skimp than IL new enrollees (27.1% vs. 36.7%) but the IL rollovers still improved significantly and achieved comparable levels to IL new after SC (15.4% vs. 14.8%, respectively). When respondents were categorized by demographic and health factors into tertiles of pre-SC risk of skimping, the 3 groups achieved proportional reductions in skimping of 46% to 63%. The improvement in the absolute risk of skimping, however, was greatest in the highest tertile. While skimping in the lowest tertile fell from 14.4% to 7.8%, it declined from 45.5% to 17.0% in the highest tertile. The absolute differences of 6.6 and 28.5 percentage-points, respectively, mean that SC averted skimping for only 1 in 15 low-risk enrollees, but for 2 out of 7 high-risk enrollees. CONCLUSIONS: The two state PAPs studied here cut the proportion of seniors who reported going without necessities or skimping on prescribed drugs by more than half, and those at greatest risk of skimping benefited the most. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Pharmacy programs should be designed for and targeted to persons at greatest risk of skimping to maximize the likely health gains.
Publication Types:
Keywords:
- Data Collection
- Female
- Humans
- Illinois
- Income
- Interviews as Topic
- Medicaid
- Pharmacies
- Pharmacy
- Poverty
- Prescriptions, Drug
- Wisconsin
- economics
- hsrmtgs
UI: 103623104
From Meeting Abstracts