22% of Seniors Skip or Don’t Purchase Prescription Medications Due to Cost, Survey Finds

About 22% of seniors said that they skipped doses of prescription drugs or did not buy the medications they needed in 2001 because the cost was too high, according to an eight-state survey conducted by researchers at Boston-based Tufts-New England Medical Center, the Kaiser Family Foundation and the Commonwealth Fund (Pugh, Philadelphia Inquirer, 8/1). For seniors without prescription drug coverage, the percentage who skipped doses or did not purchase needed drugs was higher, about 35%. Many seniors with severe and chronic conditions, such as heart disease or diabetes, also skipped medications or did not fill prescriptions because of cost, the survey indicates. Results from the survey were published yesterday in the online version of the journal Health Affairs and in a companion report called "Seniors and Prescription Drugs: Findings from a 2001 Survey of Seniors in Eight States." Researchers surveyed 10,927 Medicare beneficiaries living in California, Colorado, Illinois, Michigan, New York, Ohio, Pennsylvania and Texas in 2001 (KFF/Commonwealth Fund release, 7/31). About 42% of American seniors and 41% of low-income seniors -- those with incomes below 200% of the poverty level, or $17,720 for an individual -- live in the surveyed states.

Among states in the survey, Illinois, Michigan, New York and Pennsylvania have implemented prescription drug programs for seniors. According to the survey, there are "considerable state-level variations" in the number of seniors who have prescription drug coverage. Seniors in California, New York and Pennsylvania are the least likely to lack drug coverage, while those in Texas and Illinois are the most likely to lack drug coverage. Only 11% of poor seniors -- those with incomes at or below 100% of the poverty level, or $8,860 for an individual -- in New York lacked drug coverage in 2001, compared with 38% of poor seniors in Michigan and Colorado. In addition, the survey notes that sources through which seniors obtained drug coverage varied, with 50% of seniors in Michigan and Ohio having drug expenses covered through employer-based drug plans. The survey says the high percentage of employer-sponsored coverage there is likely attributed to those states' large auto and steel industries, which tend to offer more generous benefits than some other industries. In California and Colorado, seniors were more likely to obtain drug coverage through Medicare managed care plans. Researchers also examined seniors' out-of-pocket drug costs, finding that 23% of all seniors spent more than $100 per month on prescription medications, and that 43% of seniors without drug coverage spent more than $100 per month. Drug coverage "var[ied] considerably" in protecting against out-of-pocket costs; according to the survey, seniors receiving drug coverage through Medicaid had the least out-of-pocket expenses, while Medigap plans offered seniors the "least financial protection" against such expenses.

The study concluded that "classifying beneficiaries as either having [drug] coverage or not misses major differences in the depth of coverage" and noted that some drug plans are "only marginally better than no coverage at all." In addition, researchers concluded that "national-level data [can] ... mask important variations across states" and that "further erosion of drug coverage ... seems inevitable" (Safran et al., Health Affairs, 7/31). Kaiser Commission on Medicaid and the Uninsured Executive Director Diane Rowland said, "This is not about ranking states. ... The findings here underscore that coverage matters and the comprehensiveness of that coverage matters for how the elderly use their medications and what medications they get" (Ferguson, Gannett News Service/Detroit News, 8/1). The study also surmises that even in states that make efforts to cover seniors' drug costs through Medicaid or other assistance programs, a "substantial percentage" of low-income seniors still lacked coverage in 2001. The report concludes that the "need for a national policy solution [on prescription drug coverage] is clear" (Health Affairs, 7/31). John Rother, AARP's director of policy and strategy, called the study's results "alarming," saying that the "patchwork of [prescription drug] coverage that some seniors have relied on is coming apart." He said Congress should pass legislation that adds a prescription drug benefit to Medicare. Dana Gelb Safran, the study's lead author, said that amendments defeated over the last two weeks in the Senate that would have given low-income seniors prescription drug benefits through Medicare would have been an "excellent start" to improving coverage (Baker, California Healthline, 7/31). The study is available online.