December 1, 2002
Cathy Schoen, Sabrina K. H. How, David Sandman, Ph.D., and Deirdre Downey
New York Seniors and Prescription Drugs: Seniors Remain at Risk Despite State Efforts, David Sandman, Ph.D., Cathy Schoen, M.S., Deirdre Downey, and Sabrina How, The Commonwealth Fund, December 2002
While New York has one of the largest and most effective senior drug assistance programs in the country, nearly one of five seniors residing in the state in 2001 had no coverage for medications, according to a new Commonwealth Fund report. As a result of lack of coverage or inadequate benefits, one-fifth of all New York seniors and one-third of seniors without drug coverage reported that they skipped doses of medication or did not fill a prescription because of cost concerns. One-fifth of the state's 2.4 million seniors have monthly out-of-pocket expenses of more than $100 for prescription drugs.
The study, New York Seniors and Prescription Drugs: Seniors Remain at Risk Despite State Efforts, was based on findings from an eight-state survey of the elderly sponsored by the Henry J. Kaiser Family Foundation, The Commonwealth Fund, and Tufts-New England Medical Center. The authors note that New York's two key public programs to supplement Medicare for seniorsMedicaid and Elderly Pharmaceutical Insurance Coverage (EPIC)in combination reach just one-third of seniors with incomes at or below 200 percent of the federal poverty level.
Evidence exists that New York's public insurance programs are failing to reach all the elderly who are eligible to participate. Many seniors are not aware of the state's EPIC pharmaceutical benefit program: only 60 percent of seniors with incomes that would potentially make them eligible for EPIC had heard of it. In 2001, New York Medicaid drug benefits covered fewer than half (45%) of seniors with incomes below poverty. One-third (34%) of poor seniors who indicated they were aware of Medicaid but not enrolled in it thought they had too much money to qualify. Improved outreach and simplified eligibility rules and application procedures could help these programs reach more of the elderly, the authors note.
Levels of access to needed medications and protection against high out-of-pocket costs were found to vary markedly by source of drug benefits. Medicaid provides the best protection against high drug costs, followed by employer-sponsored coverage (i.e., retiree benefits). Just 4 percent of seniors with Medicaid and 12 percent with employer coverage spend $100 or more per month on drugs. In contrast, more than one-third (35%) of seniors who rely on Medigap coverage purchased to supplement Medicare spend $100 a month or more on drugs.Facts and Figures
- In 2001, one-third of New York seniors without drug coverage who had congestive heart failure, diabetes, or hypertension skipped doses of their medications. This is in contrast to only 9 to 14 percent of seniors with such chronic illnesses who had drug benefits.
- One-third (35%) of New York seniors without drug coverage spent $100 or more per month on their medications--twice the rate (17%) of those with coverage.
- One of five (19%) low-income New York seniors spent less on food and rent in order to afford medications.