Enrollment and Benefit Design
In general, SPAPs are targeted to low-income individuals. Across the 15 states, they reached an average of one-third of those potentially eligible, ranging from 7 percent in Michigan to 64 percent in Pennsylvania. (These figures do not account for other drug coverage, which in some states prevents people from participating.) Programs with the fewest restrictions on enrollmentsuch as up-front fees or deductibles or in-person interviewshad the highest participation rates. In addition, the authors find that cost-sharing for drugs at the point of sale only minimally curtailed enrollment levels. The researchers found that simplifying application procedures encouraged enrollment. Over time, many states have moved toward shorter forms, and some have used income tax records to verify eligibility. In addition, several states have had success in targeting certain hard-to-reach populations, including non-English speakers and inner-city and rural residents, by working through local churches or canvassing neighborhoods.
Program Reach
While SPAPs have had limited reach thus far, their influence is growing. By January 2003, there were 26 programs in existence, and many states had expanded eligibility levels and benefits in these programs. More accurate state-level data on pharmacy coverage are needed to determine the size and distribution of the eligible population and calculate take-up rates.
Facts and Figures
- The 15 SPAPs in operation in 2000 enrolled approximately 903,000 people.
- Among the six states without a fee, deductible, or in-person interview, more than half (56%) of eligible people were enrolled in pharmacy programs.
- Among states with any of these requirements, however, only 19.4 percent of eligible persons were enrolled.