Dawn E. Havrda, PharmD, BCPS; Beth A. Omundsen, MD; William Bender, MD; Mary Ann Kirkpatrick, PhD
Acknowledgments: The authors thank Estee Graves, PharmD, and Arthur Harralson, PharmD, BCPS for their substantial contributions.
Grant Support: None.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Reprints: Dawn E. Havrda, PharmD, BCPS, Shenandoah University School of Pharmacy, 1775 North Sector Court, Winchester, VA 22601; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Havrda and Kirkpatrick: 1775 North Sector Court, Winchester, VA 22601.
Drs. Omundsen and Bender: Amherst Family Practice, 1867 Amherst Street, Winchester, VA 22601.
Low-income Medicare beneficiaries without prescription benefits have high out-of-pocket medication expenses that can discourage adherence to treatment regimens. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 created a temporary drug discount card program and a prescription benefit with low-income provisions to assist with medication expenditures for eligible seniors.
To determine the impact of the new drug discount card and prescription benefit on medication expenditures by low-income Medicare recipients who require pharmaceutical company assistance for obtaining medications.
Retrospective, nonrandomized evaluation.
Family practice physicians' office in northern Virginia.
137 Medicare recipients without prescription coverage who received assistance from pharmaceutical companies for medications.
Patients were stratified into 3 categories according to income, household size, and the federal poverty line (FPL), as defined by the new Medicare act. Participants' long-term oral and inhaled medications, dosages, and instructions for use were obtained. The MMA criteria for low-income provisions were applied for the drug discount program and for the prescription benefit. Medication costs under the new Medicare benefits were compared with those incurred without assistance and with the use of pharmaceutical company programs for the cohort and FPL categories.
In all income categories, medication costs were lower after enrollment in all programs than those of patients without assistance. Compared with pharmaceutical company assistance, Medicare drug discount cards resulted in less savings for all income groups. For the prescription benefit, persons with incomes less than 135% of FPL had the greatest benefit because of low-income subsidies. Persons ineligible for low-income subsidies receiving the standard benefit had a smaller reduction in out-of-pocket costs and variable monthly expenditures; they realized a superior savings with pharmaceutical company assistance programs.
The generalizability of these findings is limited because the authors used a discount pharmacy to determine drug costs for persons receiving no assistance, could not determine asset criteria for the MMA drug benefit low-income subsidy, and used a selected Medicare population.
In a low-income Medicare population without prescription coverage, pharmaceutical company programs offered considerable savings and were superior to the Medicare drug discount cards. For the Medicare prescription plan, the greatest savings was among those eligible for low-income subsidies. Month-to-month medication costs may vary substantially for persons ineligible for such subsidies, and pharmaceutical company assistance may be a better alternative.
Table 1. Overview of Benefits of the Medicare Drug Discount Card Program
Table 2. Overview of Benefits of the Medicare Prescription Drug Benefit
Table 3. Patient Characteristics
Table 4. Total Estimated Out-of-Pocket Yearly Medication Expenditures and Savings Compared with No Assistance
Monthly estimated drug expenditures for the Medicare prescription drug benefit for incomes greater than 135% of federal poverty line (FPL).
Table 5. Patient Scenarios and Out-of-Pocket Medication Expenses
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Havrda DE, Omundsen BA, Bender W, Kirkpatrick MA. Impact of the Medicare Modernization Act on Low-Income Persons. Ann Intern Med. ;143:600–608. doi: 10.7326/0003-4819-143-8-200510180-00011
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Published: Ann Intern Med. 2005;143(8):600-608.
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