Chartpack Medicare Prescription Drug Benefit Progress Report: Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors and Prescription Drugs August 2007
Methodology The National Survey of Seniors and Prescription Drugs, 2006 was designed and analyzed by researchers at the Kaiser Family Foundation, The Commonwealth Fund, and Tufts New England Medical Center. The survey of 16,072 seniors was administered in English and Spanish between October 5 and December 20, 2006, primarily by mail with telephone follow-up. The study used an augmented longitudinal design that included respondents to our 2003 national survey of seniors and a randomly selected nationally representative sample of non-institutionalized Medicare beneficiaries age 65 and older that was provided by the Centers for Medicare and Medicaid Services in June 2006. After accounting for beneficiaries excluded because of death, institutionalization, relocation, non-english/spanish language, or severe cognitive or physical impairment, the final study sample had a response rate of 56 percent. The survey had a margin of sampling error of less than 1 percent. Bivariate and multivariate methods were used to examine seniors prescription drug coverage, use, out-of-pocket spending, adherence, and experiences in a Part D plan. This chartpack is based on an article (published online 21 August 2007) in Health Affairs, Medicare Prescription Drug Benefit Progress Report: Findings from a 2006 National Survey of Seniors available at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.5.w630 The charts were prepared by Tricia Neuman, Michelle Kitchman Strollo, and Kim Boortz of the Kaiser Family Foundation; Stuart Guterman and Sophie Kasimow of the Commonwealth Fund; Angela Li of the Tufts-New England Medical Center; and Dana Gelb Safran of Blue Cross Blue Shield of Massachusetts.
Prescription Drug Coverage of Non-Institutionalized Seniors
Chart 1 Share of Seniors Who Said They Were Without Drug Coverage in 2005 and 2006 33% 8% 2005 2006 NOTES: Sample excludes institutionalized seniors. Numbers are rounded.
Chart 2 Distribution of Seniors Drug Coverage in 2006 Among Those Who Did Not Have Drug Coverage in 2005 Drug coverage in 2005: Source of Drug Coverage in 2006: 20% No Rx Coverage 5% 7% 7% VA Employer Other Yes 67% No 33% 61% Part D NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded.
Chart 3 Distribution of Seniors by Primary Source of Drug Coverage, 2006 Employer Part D 31% 50% None 8% 7% 3% VA Other Coverage NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded.
Chart 4 Part D Coverage Rates Among Seniors with Selected Characteristics, 2006 Total Race/Ethnicity White African American Non-White Hispanic % Poverty 100% 101-150% 151-200% >200% Chronic Conditions None 1 or 2 3 or more 40% 41% 50% 48% 62%* 66%* 74%* 63%* 54%* 50%* 54%* NOTES: Sample excludes institutionalized seniors. Weighted percentages. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Reference groups for statistical significance include: white, >200% poverty, and no chronic conditions (*p < 0.05). Numbers are rounded.
Chart 5 Lack of Any Drug Coverage Among Seniors with Selected Characteristics, 2006 Total 8% Urban/Rural Location Rural Urban Race/Ethnicity White African American Non-White Hispanic % Poverty 100% 101-150% 151-200% >200% Chronic Conditions None 1 or 2 3 or more 7% 8% 7% * 5% * 8% 8% 10% * 10% 12% * 11% * 14% * NOTES: Sample excludes institutionalized seniors. Weighted percentages. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Reference groups for statistical significance include: white, >200% poverty, and no chronic conditions (*p < 0.05). Numbers are rounded. 23%
Chart 6 Seniors Drug Coverage in Selected States, 2006 44%* 50% 49% 46%* 52% 50% 57%* 63%* 34% 36%* 23%* 31% 35%* 33% 24%* 21%* 4% 3% 3% 2% 4% 2%* 7% 4% 11%* 3% 4%* 13%* 8% 6%* 8% 5%* 8% 10% 7% 6%* 8% 10% 9% 8% Part D Employer VA Other No Rx Coverage Total CA FL NY OH PA TX 7 State Rural Region NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Seven state rural region includes: IA, MN, MT, ND, NE, SD, WY. Reference group for statistical significance is Total (*p<0.05). Numbers are rounded.
Chart 7 Low-Income Seniors Drug Coverage in Selected States, 2006 57%* 58%* 68% 66% 71% 68% 77%* 74%* 10% 21%* 3% 10% 10% 12% 2% 4%* 10% 1% 2% 13%* 6% 2% 2% 8% 3% 2% 3%* 9% 6% 6% 16%* 7% 12% 15% 16% 11% 12% 13% 7%* 10% Part D Employer VA Other No Rx Coverage Total CA FL NY OH PA TX 7 State Rural Region NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Seven state rural region includes: IA, MN, MT, ND, NE, SD, WY. Low-income refers to seniors at or below 150% of poverty (<$14,700/individual and <$19,800/couple). Reference group for statistical significance is Total (*p<0.05). Numbers are rounded. 10
Characteristics of Non- Institutionalized Seniors with Various Sources of Drug Coverage 11
Chart 8 Income Distribution of Seniors, by Source of Drug Coverage, 2006 58% 10% 18% 14% 46% 45% 57% 82%* 11% 9% 23% 18%* 23% 17%* 9%* 21% 23% 8%* 8%* 2%* >200% FPL 150-200% FPL 101-150% FPL 100% FPL Total Part D Employer VA None NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. "Other coverage" is not shown. In 2006, federal poverty level (FPL): $9,800/individual and $13,200/couple. The reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. 12
Chart 9 Race/Ethnicity of Seniors, by Source of Drug Coverage, 2006 6% 5% 3% 8% 6% 4%* 3%* 3% 3%* 2%* 1% 8% 6% 3% 5% 86% 90%* 95%* 83% 81% African American Non-White Hispanic Asian/Other White Total Part D Employer VA None NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D Coverage (*p < 0.05). Numbers are rounded. 13
Chart 10 Rural/Urban Residence of Seniors, by Source of Drug Coverage, 2006 76% 76% 79%* 68%* 71%* Urban Rural 24% 24% 21%* 33%* 29% Total Part D Employer VA None NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. 14
Chart 11 Number of Prescriptions Taken by Seniors, by Source of Drug Coverage, 2006 12%* 24% 25% 25% 31%* 32%* 44% 45% 45% 21% 21% 21% 48% 14% 26%* 30%* 7 or more 3 to 6 1 or 2 None 11% 9% 10% 7% Total Part D Employer VA None NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. 15
Prescription Drug Use, Out-of-Pocket Spending, and Non-Adherence 16
Chart 12 Mean Number of Prescriptions Filled by Seniors, by Source of Drug Coverage, 2006 (Among Seniors Taking 1 or More Rx) Total Part D Employer VA Other No Rx Coverage 4.9 5.0 5.0 5.6* 4.7* 6.3 6.3 6.5 6.5 5.8* 5.6* 4.0* All Seniors Seniors with 3+ Chronic Conditions NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. 17
Chart 13 Share of Seniors Spending More Than $300 on Prescriptions in the Last 30 Days, by Source of Drug Coverage, 2006 (Among Seniors Taking 1 or More Rx) Total Part D Employer VA Other No Rx Coverage 14% 11%* 10% 11% 11% 7% 8% 8% 8%* 7%* 5%* 5%* All Seniors Seniors with 3+ Chronic Conditions NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. 18
Chart 14 Share of Seniors Who Did Not Fill or Delayed Filling Prescriptions Due to Cost, by Source of Drug Coverage, 2006 (Among Seniors Taking 1 or More Rx) Total Part D Employer VA Other No Rx Coverage 35%* 16% 20% 23%* 15%* 12%* 21% 25% 18%* 16%* 12%* 8%* All Seniors Seniors with 3+ Chronic Conditions NOTES: Sample excludes institutionalized seniors. Did not fill/delayed filling refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. 19
Chart 15 Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-Adherence, 2006 (Odds Ratios) Source of Coverage vs. Reference Group Spent >$100 in the Last 30 Days Spent >$300 in the Last 30 Days Did Not Fill/Delayed Fill or Refill Due to Cost in the Past 12 Months None vs. Part D 2.3 2.0 1.4 Part D vs. Employer 1.8 2.3 2.2 Part D vs. VA 1.7 3.3 1.6 Notes: Sample excludes institutionalized seniors. Findings based on three separate models each of which controlled for demographics, health measures, selfreported diseases, number of duals, and source of coverage. Among seniors taking one or more prescription medications. VA is Department of Veterans Affairs. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Dugs, 2006. 20
Chart 16 Share of Seniors Who Purchased Prescriptions From Canada or Mexico, by Source of Drug Coverage, 2006 (Among Seniors Taking 1 or More Rx) Total 4% Part D 5% Employer 2%* VA 5% Other 4% No Rx Coverage 10%* NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. 21
Characteristics and Cost-Related Experiences of Non-Institutionalized Seniors in Part D Plans 22
Chart 17 Part D Enrollment Among Seniors, by Plan Type, 2006 Medicare Advantage Prescription Drug Plan (MAPD) 30% Stand-Alone Prescription Drug Plan (PDP) 70% NOTES: Sample excludes institutionalized seniors. Numbers are rounded. 23
Chart 18 Share of Seniors in Part D Plans (PDP vs. MAPD) with Selected Characteristics, 2006 Age 85+ 12% 12%* 10% Total Part D 100% Poverty Rural location 7% 13% 21% 24%* 24% 31%* Stand-Alone Prescription Drug Plan (PDP) Medicare Advantage Prescription Drug Plan (MAPD) 7+ Rx (per month) 23% 28% 30%* 3+ Chronic Conditions 37% 43% 45%* NOTES: Sample excludes institutionalized seniors. Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. 24
Chart 19 Race/Ethnicity of Seniors in Part D Plans, by Part D Plan Type, 2006 6% 5%* 8% 8% 8% 7% 83% 83% 82% Non-White Hispanic African American White Total Part D Stand-Alone Prescription Drug Plan (PDP) Medicare Advantage Prescription Drug Plan (MAPD) NOTES: Sample excludes institutionalized seniors. Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. 25
Chart 20 Prescription Out-of-Pocket Spending and Non-Adherence Among Seniors in Part D Plans, by Part D Plan Type, 2006 (Among Seniors Taking 1 or More Rx) 21%* 20% 17% 28%* 26% 22% Total Part D Stand-Alone Prescription Drug Plan (PDP) Medicare Advantage Prescription Drug Plan (MAPD) 8% 8%* 7% Did Not Fill/Delayed Filling Due to Cost Spent >$100 in the Last 30 Days Spent >$300 in the Last 30 Days NOTES: Sample excludes institutionalized seniors. Did not fill/delayed filling refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. 26
The Part D Low-Income Subsidy (LIS) 27
Chart 21 Drug Coverage Among Seniors with Incomes At or Below 150% of Poverty Who Were Not Receiving the Low- Income Subsidy (LIS), 2006 Other 14% No Rx Coverage 16% Employer/ VA 23% Part D 48% Nearly half of all seniors at or below 150% of poverty without the low-income subsidy are in a Part D plan NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. 28
Out-of-Pocket Spending on Prescriptions and Non-Adherence Among Low-Income Seniors in Part D Plans, With and Without the Low-Income Subsidy (LIS), 2006 22% 27% Chart 22 (Among Seniors Taking 1 or More Rx) With LIS (excluding Dual Eligibles) 32% Without LIS 11%* 9% 4%* Did Not Fill/Delayed Filling Due to Cost Spent >$100 in the Last 30 Days Spent >$300 in the Last 30 Days NOTES: Sample excludes institutionalized seniors. Did not fill/delayed filling refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: with LIS versus without LIS (*p < 0.05). Low-income is defined as at or below 150% of poverty. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. 29
Chart 23 Share of Seniors With Incomes At or Below 150% of Poverty Who Said That They Were Not Aware of the Part D Low-Income Subsidy (LIS), Among Those Not Receiving The LIS, 2006 Total 48% % Poverty 100% 101% - 134% 135% - 150% Race/Ethnicity White African American Non-White Hispanic 53%* 50%* 43% 46% 65%* 65%* NOTES: Sample excludes institutionalized seniors. Weighted percentages. Reference Groups: 135-150% of poverty, white, and Part D Rx Coverage (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. 30
Chart 24 Seniors in Part D Plans Who Spent More Than $100 on Prescriptions in the Last 30 Days, by Income Level and Low-Income Subsidy (LIS) Status, 2006 (Among Seniors Taking 1 or More Rx) 32% 35% 33% 26% 7%* 11%* Total Part D Dual Eligibles 150% Poverty With LIS 150% Poverty Without LIS 151-200% Poverty >200% Poverty NOTES: Sample excludes institutionalized seniors. Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group, except as indicated (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. 31
Seniors in Part D Plans Who Spent More Than $300 on Prescriptions in the Last 30 Days, by Income Level and Low-Income Subsidy (LIS) Status, 2006 8% Chart 25 (Among Seniors Taking 1 or More Rx) 9% 11% 10% 2%* 4%* Total Part D Dual Eligibles 150% Poverty With LIS 150% Poverty Without LIS 151-200% Poverty >200% Poverty NOTES: Sample excludes institutionalized seniors. Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group, except as indicated (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. 32
Chart 26 Seniors in Part D Plans Who Did Not Fill or Delayed Filling a Prescription Due to Costs, by Income Level and Low-Income Subsidy (LIS) Status, 2006 (Among Seniors Taking 1 or More Rx) 27%* 26%* 20% 20%* 22%* 15% Total Part D Dual Eligibles 150% Poverty With LIS 150% Poverty Without LIS 151-200% Poverty >200% Poverty NOTE: Sample excludes institutionalized seniors. Did not fill/delayed filling refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. 33
Chart 27 Part D Enrollees Experiences Since Enrolling in a Part D Plan, by Income Level and Low-Income Subsidy (LIS) Status, 2006 (Among Seniors Taking 1 or More Rx) Total Dual Eligibles 150% FPL w/ LIS 150% FPL w/out LIS 151-200% FPL >200% FPL 20%* 8% 11%* 8% 13% 11% 10% 8% 8% 8% 7% 6% Changed Part D Plans Needed Permission to Fill Rx NOTE: Sample excludes institutionalized seniors. Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level (FPL): $9,800/individual and $13,200/couple. Numbers are rounded. 34
Chart 28 Share of Part D Enrollees Who Started Ordering Prescriptions by Mail, by Income Level and Low-Income Subsidy (LIS) Status, 2006 (Among Seniors Taking 1 or More Rx) 21% 15% 15%* 13%* 9%* 6%* Total Part D Dual Eligibles 150% Poverty with LIS 150% Poverty without LIS 151-200% Poverty >200% Poverty NOTE: Sample excludes institutionalized seniors. Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. 35
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