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Medicare Compliance & Reimbursement

PART D:

Enrollees Still Fall Through Subsidy Cracks

Published on Sun Sep 09, 2007

Drugs are still difficult for many seniors to afford, researchers say

A new study focusing on Medicare prescription drug beneficiaries suggests that although the program has extended drug coverage to those who had none before the advent of Medicare Part D, many beneficiaries are still facing more financial hardships than they should because of drug-related costs.

Millions of beneficiaries who would likely qualify for supplemental assistance aren't even applying for assistance, says Tricia Neuman, a principal researcher at the Kaiser Family Foundation.

Findings from the survey, conducted jointly by the Kaiser Family Foundation, the Commonwealth Fund and the Tufts-New England Medical Center, were published in Health Affairs in August.

Seniors Pay 'Sizeable' Out-Of-Pocket Costs

The survey of more than 16,000 seniors found that those enrolled in the Medicare drug benefit reported fewer cost pressures than those without coverage, but more financial headaches than those with coverage through employers or the U.S. Dept. of Veterans Affairs.

"The Medicare drug law achieved its primary goal of providing drug coverage to most seniors who previously lacked it," said Drew Altman, president and CEO of the Kaiser Family Foundation. "But the survey found a significant number of seniors in Part D plans paying sizeable amounts out of pocket for their medications and delaying or not filling their prescriptions for cost reasons."

Though the beneficiaries surveyed offered various explanations on why they hadn't applied for assistance, a common denominator emerged.

"We were surprised to see that there were many people reporting that they were just not aware of the subsidy," says Neuman.

Those saying that they didn't know about the subsidies included enrollees and some seniors who hadn't yet signed up for Medicare's fledgling drug benefit.

For pharmacists, that suggests that some patient advocacy could pay off. Medicare Part D may not be perfect, but it's better than no coverage at all--especially for nonenrolled seniors who may, through subsidies, avoid high out-of-pocket costs associated with Part D, Neuman says.

What Beneficiaries Are Paying On Their Own

More than 11 percent of Part D enrolled seniors with three or more chronic conditions said they paid more than $300 per month for prescription drugs.

"[Part D] has helped in expanding coverage to people who didn't have it, and that is a great thing, But there is still work to be done in making medications more affordable to seniors," Newman says.

7.8 Percent Pay Over $300 Per Month

Here's how coverage compared: 7.8 percent of those with Part D coverage spent more than $300 per month on prescriptions, compared with 4.8 percent of those covered by employees, 4.7 percent covered by VA, and 10.9 percent with no coverage.

The percentages of those who did not fill or delayed filling their prescriptions due to cost were higher: Part D beneficiaries rang in at 8.1 percent, VA at 11.5 percent and noncovered at 23.2 percent. These findings were charted in "Medicare Prescription Drug Benefit Progress Report: Findings From A 2006 National Survey Of Seniors," in the Aug. 2007 Health Affairs.

To see the study and related materials, go to www.kff.org/rxdrugs/index.cfm.

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