Exploring Prescription Drug Coverage and Drug Use for Older Americans

Abstract

Spanish

French

OBJECTIVE:

To describe existing prescription drug insurance coverage for older Americans, to describe out-of-pocket payment levels per prescription associated with service benefit prescription drug plans used by older persons, and to examine the association of prescription drug coverage types with the reported use of prescription drugs by older persons.

PATIENTS AND METHODS:

Data were obtained from a national survey of 1570 community-dwelling older persons (≥65 y) conducted in June 1998. A 2-part utilization model was estimated using logistic regression and ordinary least-squares regression.

RESULTS:

Data from 310 respondents were used for analysis. Overall, 66.1% of respondents reported having prescription drug insurance coverage. A majority (76.6%) of respondents having private drug coverage reported having a service benefit plan (requiring copayment or coinsurance amount to be paid for each prescription). The median copayment per brand name and generic prescription for persons reporting having coverage by service benefit plans was $10 and $5, respectively.

CONCLUSIONS:

Overall, a majority of older persons reported paying relatively small amounts out-of-pocket per prescription during 1998. Among persons who reported having drug insurance coverage, there were no statistically significant differences in the reported number of drugs used daily, regardless of out-of-pocket payment amount per prescription. Patient need and level of past drug use were significantly associated with both the likelihood of using any prescription drugs and the level of use among users. More research is needed to examine differences in drug expenditures and characteristics of drugs used across prescription drug insurance types for older persons.

Keywords

elderly insurance Medicare

Get full access to this article

View all access options for this article.

References

Washington

. Testimony on prescription drug coverage for Medicare beneficiaries before the House Commerce Health and Environment Subcommittee, Washington, DC. February 16, 2000 [cited 2001 March 19]. Available from: URL: www.hcfa.gov/testimony/2000/000216.htm.

Statistical abstract of the United States: 1998. Washington, DC: US Bureau of the Census, 1998.

Adamcik

. The consumers of health care. In: Fincham

Wertheimer

, eds. Pharmacy and the US health care system. 2nd ed. Binghampton, NY: Pharmaceutical Products Press, 1998: 337–94.

Sullivan

Gardner

Strandberg

. The economics of outpatient prescription drug coverage for the elderly: Implications for healthcare reform. Generations 1994;18(2):55–60.

Families USA, Cost overdose: growth in drug spending for the elderly, 1992–2010. Washington DC, 2000.

Report to the President. Prescription drug coverage, spending, utilization and prices. Washington, DC: US Department of Health and Human Services, 2000.

Poisal

Chulis

. Medicare beneficiaries and drug coverage. Health Aff 2000;19: 248–56.

Medigap policies and protections [cited 2002 Jan 10]. Available from: URL: www.medicare.gov/publications/pubs/pdf/finalmed.pdf.

Wolfe

Goddeeris

. Adverse selection, moral hazard, and wealth effects in the Medigap insurance market. J Health Econ 1991;10: 433–59.

10.

Coulson

Terza

Neslusan

Stuart

. Estimating the moral-hazard effect of supplemental medical insurance in the demand for prescription drugs in the elderly. Am Econ Rev 1995;85: 122–6.

11.

Coulson

Stuart

. Insurance choice and the demand for prescription drugs. South Econ 1995;61: 1146–57.

12.

Johnson

Goodman

Hornbrook

Eldredge

. The impact of increasing patient prescription drug cost sharing on therapeutic classes of drugs received and on the health status of elderly HMO members. Health Serv Res 1997;32(1):103–22.

13.

Lassila

Stoehr

Ganguli

Seaburg

Gilby

Belle

Use of prescription medications in an elderly rural population: The MoVIES project. Ann Pharmacother 1996;30: 589–95.

14.

Dillman

. Mail and telephone surveys: the total design method. New York: Wiley Publishing, 1978.

15.

Prescription benefits under state medical assistance programs. Reston, VA: National Pharmaceutical Council, 1998.

16.

Long

. Prescription drugs and the elderly: Issues and options. Health Aff 1994;13(2):157–74.

17.

Duan

Manning

Morris

Newhouse

. A comparison of alternative models for the demand for medical care. J Bus Econ Stats 1983;1: 115–26.

18.

McClellan

Spatz

Carney

. Designing a Medicare prescription drug benefit: Issues, obstacles, and opportunities. Health Aff 2000;19(2):26–41.

19.

Martin

McMillan

. The impact of implementing a more restrictive prescription limit on Medicaid recipients: Effects on cost therapy and out-of-pocket expenditures. Med Care 1996;34: 686–701.

20.

Steinberg

Gutierrez

Momani

Boscarino

Neuman

Deverka

. Beyond survey data: A claims-based analysis of drug use and spending by the elderly. Health Aff 2000;19(2):198–211.

21.

Osler

Schroll

. Differences between participants and non-participants in a population study on nutrition and health in the elderly. Eur J Clin Nutr 1992;46: 289–95.

22.

Berk

Schur

Mohr

. Using survey data to estimate prescription drug costs. Health Aff 1990;9: 146–57.

23.

Grotzinger

Stuart

Ahern

. Assessment and control of non-response bias in a survey of medicine use by the elderly. Med Care 1994;32: 989–1003.