Medicare Prescription Drug Benefit Progress Report:
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1 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
2 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 followup. 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 noninstitutionalized Medicare beneficiaries age 65 and older that was provided by the Centers for Medicare and Medicaid Services in June 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.
3 Prescription Drug Coverage of Non-Institutionalized Seniors
4 Chart 1 Share of Non-Institutionalized Seniors Who Said They Were Without Drug Coverage in 2005 and % 8% NOTES: Numbers are rounded.
5 Chart 2 Distribution of Non-Institutionalized 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: 5% 7% 7% VA Employer Other 20% No Rx Coverage Yes 67% No 33% 61% Part D NOTES: VA is Department of Veterans Affairs. Numbers are rounded.
6 NOTES: VA is Department of Veterans Affairs. Numbers are rounded. Chart 3 Distribution of Non-Institutionalized Seniors by Primary Source of Drug Coverage, 2006 Employer Part D 31% 50% None 8% 7% 3% VA Other Coverage
7 Chart 4 Part D Coverage Rates Among Seniors with Selected Characteristics, 2006 Total Race/Ethnicity White African American Hispanic % Poverty <100% % % >200% Chronic Conditions None 1 or 2 3 or more 40% 41% 50% 48% 62%* 66%* 74%* 63%* 54%* 50%* 54%* NOTES: 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.
8 NOTES: 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 10% * Urban 8% Race/Ethnicity White African American Hispanic 8% 12% * 10% % Poverty <100% % % >200% Chronic Conditions None 1 or 2 3 or more 8% 7% 7% * 5% * 11% * 14% * 23%
9 Chart 6 Seniors Drug Coverage in Selected States, %* 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: 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.
10 Chart 7 Low-Income Seniors Drug Coverage in Selected States, %* 58%* 68% 66% 71% 68% 77%* 74%* 10% 21%* 3% 10% 10% 12% 2% 4%* 10% 1% 2% 13%* 6% 2% 2% 8% 3%* 3% 9% 2% 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: 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. Reference group for statistical significance is Total (*p<0.05). Numbers are rounded.
11 Characteristics of Non- Institutionalized Seniors with Various Sources of Drug Coverage
12 NOTES: 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. Chart 8 Income Distribution of Non-Institutionalized Seniors, by Source of Drug Coverage, % 57% 45% 11% 82%* 9% >200% FPL % FPL % FPL <100% FPL 23% 18%* 23% 17%* 9%* 21% 23% 8%* 8%* 2%* Part D Employer VA None
13 Chart 9 Race/Ethnicity of Non-Institutionalized Seniors, by Source of Drug Coverage, % 90%* 95%* 81% White African American Hispanic Asian/Other 8% 8% 6% 3% 4%* 3%* 3% 3%* 2%* 1% 6% 5% Part D Employer VA None NOTES: 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 NOTES: 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. Chart 10 Rural/Urban Residence of Non-Institutionalized Seniors, by Source of Drug Coverage, % 79%* 68%* 71%* Urban Rural 24% 21%* 33%* 29% Part D Employer VA None
15 Chart 11 Number of Prescriptions Taken Monthly by Non- Institutionalized Seniors, by Source of Drug Coverage, %* 25% 25% 31%* 32%* 45% 45% 48% 26%* 7 or more 3 to 6 1 or 2 None 21% 21% 14% 30%* 9% 10% 7% Part D Employer VA None NOTES: 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.
16 Prescription Drug Use, Out-of-Pocket Spending, and Non-Adherence
17 NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. Chart 12 Mean Number of Prescriptions Filled by Seniors Per Month, by Source of Drug Coverage, 2006 (Among Seniors Taking 1 or More Rx) Total No Rx Coverage Part D Employer VA Other * 4.7* * * 4.0* All Seniors Seniors with 3+ Chronic Conditions
18 NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. Chart 13 Share of Seniors Spending More Than $300 Per Month on Prescriptions, by Source of Drug Coverage, 2006 (Among Seniors Taking 1 or More Rx) Total No Rx Coverage Part D Employer VA Other 14% 11%* 10% 11% 11% 7% 8% 8% 8%* 7%* 5%* 5%* All Seniors Seniors with 3+ Chronic Conditions
19 NOTES: Did not fill/delayed fill of Rx refers to not filling or delay 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. 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 No Rx Coverage Part D Employer VA Other 35%* 25% 23%* 20% 21% 16% 15%* 12%* 8%* 12%* 18%* 16%* All Seniors Seniors with 3+ Chronic Conditions
20 Chart 15 Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-Adherence, 2006 (Odds Ratios) Spend >$100/month Spend >$300/month Did not fill/delay fill 3.3 or refill due to cost in past 12 months Source of Coverage None Part D Part D None Part D Part D None Part D Part D vs. vs. vs. vs. vs. vs. vs. vs. vs. vs. Reference Group Part D Employer VA Part D Employer VA Part D Employer VA Notes: Findings based on three separate models each of which controlled for demographics, health measures, self-reported diseases, number of duals, and source of coverage. Among seniors taking one or more prescription medications. VA is Department of Veterans Affairs. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Dugs, 2006.
21 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: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded.
22 Characteristics and Cost-Related Experiences of Non-Institutionalized Seniors in Part D Plans
23 Chart 17 Part D Enrollment Among Non-Institutionalized Seniors, by Plan Type, 2006 Medicare Advantage Prescription Drug Plan (MAPD) 30% Stand-Alone Prescription Drug Plan (PDP) 70% NOTES: Numbers are rounded.
24 NOTES: 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. Chart 18 Share of Seniors in Part D Plans (PDP vs. MAPD) with Selected Characteristics, 2006 Age % 12%* 100% Poverty Rural location 7% 13% 24%* 31%* Stand-Alone Prescription Drug Plan (PDP) Medicare Advantage Prescription Drug Plan (MAPD) 7+ Rx (per month) 23% 30%* 3+ Chronic Conditions 37% 45%*
25 NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. Chart 19 Race/Ethnicity of Seniors in Part D Plans, by Part D Plan Type, % 5%* 8% 8% 8% 7% 83% 83% 82% Nonwhite Hispanic African American White Total Stand-Alone Prescription Drug Plan (PDP) Medicare Advantage Prescription Drug Plan (MAPD)
26 NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. 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) 28%* 21%* 17% 22% 8%* 7% Stand-Alone Prescription Drug Plan (PDP) Medicare Advantage Prescription Drug Plan (MAPD) Did Not Fill/Delayed Filling Due to Cost Spent >$100/month Spent >$300/month
27 Role of the Part D Low-Income Subsidy (LIS) and Non-Institutionalized Seniors Related Experiences
28 NOTES: VA is Department of Veterans Affairs. Numbers are rounded. Chart 21 Drug Coverage Among Seniors with Incomes At or Below 150% of Poverty Who Were Not Receiving the Low- Income Subsidy (LIS), 2006 No Rx Coverage 16% Other 14% Part D 48% Employer/ VA 23%
29 NOTES: Weighted percentages. Excludes dual eligibles and seniors for whom LIS status is unknown (n=686). Significance testing: with LIS versus without LIS (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. Chart 22 Characteristics of Seniors in Part D Plans, With Incomes At or Below 150% of Poverty, With and Without the Low- Income Subsidy (LIS), 2006 Age % 14% Female 78% 70% Rural Location 7+ Rx (per month) 3+ Chronic Conditions 32% 28% 37% 26% 54% 42% With LIS Without LIS
30 NOTES: Weighted percentages. Excludes dual eligibles and 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. Chart 23 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 (Among Seniors Taking 1 or More Rx) With LIS Without LIS 32% 27% 22% 11%* 9% 4%* Did Not Fill/Delayed Filling Due to Cost Spent >$100/month Spent >$300/month
31 NOTES: Weighted percentages. Reference Groups: % 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. Chart 24 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% 53%* 50%* 43% Race/Ethnicity White African American Hispanic 46% 65%* 65%*
32 Cost-Related Experiences of Non- Institutionalized Seniors in Part D Plans, by Income and Low-Income Subsidy (LIS) Status
33 Chart 25 Seniors in Part D Plans Who Spent More Than $100 Per Month on Prescriptions, 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 % Poverty >200% Poverty NOTES: 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.
34 Seniors in Part D Plans Who Spent More Than $300 Per Month on Prescriptions, by Income Level and Low-Income Subsidy (LIS) Status, % Chart 26 (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 % Poverty >200% Poverty NOTES: 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.
35 NOTE: 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. Chart 27 Seniors in Part D Plans Who Did Not Fill or Delayed Filling a Prescription Due to Costs in the Past Twelve Months, 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 % Poverty >200% Poverty
36 Chart 28 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 % 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: 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.
37 Chart 29 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 % Poverty >200% Poverty NOTE: 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.
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