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Medicare's Disabled Beneficiaries: The Forgotten Population in the Debate Over Drug Benefits

The nation's 5 million disabled Medicare beneficiaries under age 65 face a daunting combination of low income, poor health status, heavy prescription drug use, and high medication bills, according to this new report from The Commonwealth Fund and The Henry J. Kaiser Family Foundation. Yet with the exception of Medicaid, disabled Medicare beneficiaries have few options for obtaining stable and comprehensive prescription drug coverage.

In Medicare's Disabled Beneficiaries: The Forgotten Population in the Debate over Drug Benefits, researchers Becky Briesacher, Bruce Stuart, Jalpa Doshi, and Sachin Kamal-Bahl of the University of Maryland School of Pharmacy, and Dennis Shea of Pennsylvania State University, look closely at the needs and characteristics of Medicare's disabled beneficiaries—the fastest-growing segment of the Medicare population—and compare them with those of the elderly population. The authors report:

  • The disabled are heavy users of medications, filling more prescriptions than the elderly in 1998 (34 vs. 25, respectively) and spending more on drugs ($1,284 vs. $841).

  • The types of medications typically used by the disabled differ considerably from those used by the elderly.

  • Psychotherapeutics are the prescriptions most commonly filled by the disabled (57% use this group of drugs) but rank only 10th among drugs used by the elderly (23%).

  • Disabled beneficiaries are twice as likely as elderly beneficiaries to live under the federal poverty level, and nearly 80 percent live at just 200 percent of poverty or less, compared with about half of seniors.

  • More than a quarter (27%) of all under-65 disabled beneficiaries spent 5 percent or more of their annual incomes on prescription drugs in 1998.

  • Medicaid was the primary source of drug coverage for the under-65 disabled, assisting one of three such beneficiaries, but was the source for only one of 11 seniors.

Disabled beneficiaries' high drug costs and low incomes make paying for prescription medications particularly burdensome. Even though the disabled rely heavily on public programs for prescription drug coverage, most programs fail to meet their needs. Among those with private coverage, the disabled tend to have less generous benefits than the elderly.

Despite these extra burdens, disabled beneficiaries have been largely neglected in the debate over a Medicare prescription drug benefit, with most proposals focusing on the elderly. Some policymakers have in fact proposed tying a prescription benefit to those drugs most often used by the elderly. The authors demonstrate, however, that such a policy would systematically disadvantage the disabled.

Facts and Figures
  • Among under-65 disabled beneficiaries, 36 percent of those with drug coverage for only part of the year, and 44 percent of those with no coverage at all, spent 5 percent or more of their income on prescription drugs in 1998.

  • The disabled are three to four times more likely than seniors to experience difficulties in filling prescriptions, getting care, affording timely treatment, and seeing a physician when sick.

Publication Details



Medicare's Disabled Beneficiaries: The Forgotten Population in the Debate Over Drug Benefits, Becky Briesacher, Bruce Stuart, Jalpa Doshi et al., The Commonwealth Fund, September 2002