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It's the Price, Not the Prescription, That Determines How Much They Take

APRIL 25, 2005 -- Seniors often skip doses, take smaller doses, or fail to fill their prescriptions when faced with costly drug regiments, according to a Tufts–New England Medical Center study published recently in the journal Health Affairs.

Among seniors with no drug coverage, 36.8 percent did not adhere to specific drug regimens, while 35.2 percent of low-income seniors and 34.9 percent of those with three or more chronic conditions failed to adhere to their prescribed doses, researchers found.

"With one-quarter of seniors now lacking such coverage (the Medicare drug benefit) clearly has the potential to bring both financial relief and improved health care quality to this group," Dana Gelb Safran, director of the Health Institute at Tufts–New England Medical Center, stated in a news release.

But, Safran added, the report's findings "remind us that the potential for the new Medicare drug benefit to mitigate high drug spending—and enable seniors to adhere to their prescription regimens—will depend on the generosity of Part D coverage in 2006 and over the long term."

The Commonwealth Fund and the Henry J. Kaiser Family Foundation supported the research compiled by Safran and her colleagues.

Another Health Affairs article analyzes the use of a discount card program for seniors in the year before the Medicare prescription drug discount program that began in 2004. Both the drug card and the new Medicare drug benefit are part of the Medicare drug law (PL 108-173).

Enrollment and claims data show that seniors who actively enrolled in drug cards before the Medicare discount prescription drug card saved 20 percent overall on their prescription drug purchases but still spent more than $1,300 a year on medication.

The research done by senior scientist Cindy Parks Thomas and her colleagues at the Schneider Institute for Health Policy at Brandeis University showed that three-quarters of enrollees who actively purchased a card used it at least once during the year, compared with only 37 percent of those who received cards automatically as part of an insurance benefit.

"To the extent that low card use could be attributable to lack of understanding of the value of the card or how to use it, seniors and others new to a coverage program might require considerable outreach and education to be able to take advantage of it," Thomas stated in a news release. "This is important to consider in implementing Medicare Part D, in light of penalties for delayed enrollment." The research was supported in part by UnitedHealth Group.

A third report concludes that seniors with chronic medical conditions are likely to pay much more of their own money for prescription drugs than the average beneficiary under Medicare's new prescription law.

Using data from Medicare's Current Beneficiary Survey, Bruce Stuart, a professor at the University of Maryland School of Pharmacy in Baltimore, compared simulated drug spending under the Medicare Part D benefit for seniors with diabetes, chronic lung disease, and mental illness.

Given the premium, deductible and coinsurance, and uncovered expense known as the "doughnut hole," Stuart projects that the average beneficiary who signs up for the standard Medicare drug benefit will spend $722 out of pocket in 2006. By contrast, beneficiaries with one of the studied chronic conditions will pay much more: $1,581 for those with diabetes; $1,435 for those with chronic lung disease and $1,844 for those with mental illness.

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