26% Of Medicaid Beneficiaries Go Without Prescriptions, Study Finds
As states move to decrease drug spending by imposing greater restrictions on Medicaid beneficiaries, a new study has found that one out of four beneficiaries was unable to purchase a prescription drug in the last year because of cost, the New York Times reports. Facing double-digit percentage increases in drug spending, many states have adopted such measures as copayments, monthly caps on the number of prescriptions, drug formularies that encourage the use of cheaper generic drugs and prior authorization requirements. The study, conducted by the Center for Studying Health System Change, found that beneficiaries in states that imposed several cost-control techniques were significantly more likely to report not having filled a prescription because of cost, indicating that these restrictions are making it more difficult for Medicaid patients to afford drugs. "It appears that a consequence of aggressive cost-control policies is a reduction in beneficiary access to prescription drugs," the report concluded.
The study was based on a survey of 39,000 adults with a variety of coverage types, including nearly 1,800 Medicaid beneficiaries (Pear, New York Times, 4/9). The report found that 26% of beneficiaries did not fill a prescription because of cost in the past year even though every state offers Medicaid drug coverage. The rate of uninsured adults who went without a prescription because of cost was only slightly higher, at 29% (Kemper, Los Angeles Times, 4/9). In contrast, only 8% of people with employer-sponsored coverage and 8% of seniors in Medicare said they could not afford a prescription drug in the past 12 months (Carroll, Wall Street Journal, 3/9). In states with one cost-control method, or none, only 15% of Medicaid beneficiaries said they were unable to afford a prescription drug in the last year. In states with two or three of the methods, the rate was 25%; in states with four or five methods, it was 33%. While many of the cost-cutting techniques used by states are also used by private insurers, HSC's Peter Cunningham, the lead author of the study, said that Medicaid beneficiaries are affected more because they have lower incomes and are more likely to have chronic illnesses, thereby necessitating more prescriptions (New York Times, 4/9). The study found that more than 40% of beneficiaries with two or more chronic ailments could not afford a prescription in the past year (Bowman, Scripps Howard/Detroit News, 4/9). "The findings are surprising because Medicaid is expected to ensure access to affordable care for the poorest and sickest Americans," HSC vice president Len Nichols said, adding, "The study raises serious questions about the impact of state efforts to control Medicaid drug spending" (HSC release, 4/9).
State officials said that the cost-cutting measures are needed to hold down soaring drug expenses, adding that the measures do produce some benefits. "There's no question that cost-containment measures affect access to prescription drugs, but that may be a positive outcome. We know that Medicaid beneficiaries are often getting too many medications, duplicative medications from various doctors and, in some cases, medications that are contraindicated and dangerous," Joan Henneberry, a health policy expert at the National Governors' Association, said. Ray Hanley, the Medicaid director in Arkansas -- which joins North Carolina, South Carolina and Virginia as the only states with four or five cost-control measures for Medicaid beneficiaries -- added, "If anything, the copayments need to be higher. The limits on copayments have not changed in 20 years, and many people, including children and pregnant women, are exempt from copayments" (New York Times, 4/9). "Nobody wants to keep necessary medications out of the hands of Medicaid enrollees," Henneberry said, but she added that states "have to do something" (Los Angeles Times, 4/9). The report can be found online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.