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Medicare Prescription Drug Benefit Progress Report:

Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors and Prescription Drugs

August 2007

The National Survey of Seniors and Prescription Drugs, 2006 was designed and analyzed by researchers at the Kaiser Family Foundation, The Commonwealth Fund, and Tufts–New England Medical Center. The survey of 16,072 seniors was administered in English and Spanish between October 5 and December 20, 2006, primarily by mail with telephone follow-up. The study used an augmented longitudinal design that included respondents to our 2003 national survey of seniors and a randomly selected nationally representative sample of non-institutionalized Medicare beneficiaries age 65 and older that was provided by the Centers for Medicare and Medicaid Services in June 2006. After accounting for beneficiaries excluded because of death, institutionalization, relocation, non-English/Spanish language, or severe cognitive or physical impairment, the final study sample had a response rate of 56 percent. The survey had a margin of sampling error of less than 1 percent. Bivariate and multivariate methods were used to examine seniors’ prescription drug coverage, use, out-of-pocket spending, adherence, and experiences in a Part D plan.

Methodology

Prescription Drug Coverage of Non-Institutionalized Seniors

Share of Non-Institutionalized Seniors Who Said They Were Without Drug Coverage in 2005 and

2006

33%

8%

2005 2006

SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 1

NOTES: Numbers are rounded.

Distribution of Non-Institutionalized Seniors’ Drug Coverage in 2006 Among Those Who Did Not Have Drug Coverage in

2005

67% 33%

YesNo

61%

7%

5%

20%

7%

Drug coverage in 2005:


Source of Drug Coverage in 2006:

No Rx Coverage

Other

Part D

VAEmployer

NOTES: VA is Department of Veterans Affairs. Numbers are rounded.

Chart 2

3%

8%

7%

31%

50%

Part D

Employer

VA

Other Coverage

None

Distribution of Non-Institutionalized Seniors by Primary Source of Drug Coverage, 2006

NOTES: VA is Department of Veterans Affairs. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 3

40%

48%

66%*

54%*

54%*

62%*

50%*

63%*

74%*

41%

Part D Coverage Rates Among Seniors with Selected Characteristics, 2006

NOTES: Weighted percentages. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Reference groups for statistical significance include: white, >200% poverty, and no chronic conditions (*p < 0.05). Numbers are rounded.

Total

WhiteAfrican American

Hispanic

<100%101-150%

151-200%

>200%

1 or 2

3 or more

None

Race/Ethnicity

% Poverty

Chronic Conditions

50%


Chart 4

7%

10%

5%

8%

12%

7%

11%

8%

14%

23%

8%

8%

10%

Lack of Any Drug Coverage Among Seniors with Selected Characteristics, 2006

Total

WhiteAfrican American

Hispanic

<100%101-150%

151-200%

>200%

1 or 2

3 or more

None

Race/Ethnicity

% Poverty

Chronic Conditions

Rural

Urban

Urban/Rural Location *

*

*

*

*

*

NOTES: Weighted percentages. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Reference groups for statistical significance include: white, >200% poverty, and no chronic conditions (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 5

Seniors’ Drug Coverage in Selected States, 2006

8% 10% 7% 8% 10% 9% 8%

7% 8% 8%3%

4%

3%2%

4%

3% 4%

31%34%

33%

50% 49% 52% 50%

6%*

6%*11%*

13%*5%*

4%*2%*

24%*23%*36%*

35%*

21%*

57%*46%*44%*

63%*

Total CA FL NY OH PA TX 7 StateRural

Region

Part D

Employer

VA

Other

No Rx Coverage


NOTES: VA is Department of Veterans Affairs. Seven state rural region includes: IA, MN, MT, ND, NE, SD, WY. Reference group for statistical significance is Total (*p<0.05). Numbers are rounded.

Chart 6

Low-Income Seniors’ Drug Coverage in Selected States, 2006

12% 15% 11% 12% 16% 13% 10%

8%6%

9% 6% 7%

2% 2% 3%1% 2%

3%

2% 2%

10%10%

10%

10%

12%6%

68% 71%66% 68%

7%*

13%*

16%*3%*

21%*

4%*

74%*

58%*57%*

77%*

Total CA FL NY OH PA TX 7 StateRural

Region

Part D

Employer

VA

Other

No Rx Coverage

NOTES: VA is Department of Veterans Affairs. Seven state rural region includes: IA, MN, MT, ND, NE, SD, WY. Low-income refers to seniors at or below 150% of poverty. Reference group for statistical significance is Total (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 7

Characteristics of Non-Institutionalized Seniors with

Various Sources of Drug Coverage

21% 23%

23%

9%

2%*8%*

23%

8%*

17%*

11%

9%*

18%*

46%

82%*

57%45%

Part D Employer VA None

>200% FPL

150-200% FPL

101-150% FPL

<100% FPL

Income Distribution of Non-Institutionalized Seniors, by Source of Drug Coverage, 2006

NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. In 2006, federal poverty level (FPL): $9,800/individual and $13,200/couple. The reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 8

81%

5%3% 1%3%

6%

2%*3%*

6%

8%

3%*

4%*

8%

95%*90%*

83%


White

African American

Hispanic

Asian/ Other

Race/Ethnicity of Non-Institutionalized Seniors, by Source of Drug Coverage, 2006

NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D Coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 9

29%33%*21%*24%

71%*68%*79%*76%


Urban

Rural

Rural/Urban Residence of Non-Institutionalized Seniors, by Source of Drug Coverage, 2006

NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 10

9% 10%

21% 21%14%

45% 45%

25% 25%

30%*

7%

26%*48%

32%*

12%*

31%*


7 or more3 to 61 or 2None

Number of Prescriptions Taken Monthly by Non-Institutionalized Seniors, by Source of Drug

Coverage, 2006

NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 11

Prescription Drug Use, Out-of-Pocket Spending, and Non-

Adherence

4.9

6.3

5.0

6.3

5.0

6.5 6.5

5.6*

4.0*

5.6* 5.8*

4.7*

All Seniors Seniors with 3+ ChronicConditions

Total No Rx Coverage Part D Employer VA Other

Mean Number of Prescriptions Filled by Seniors Per Month, by Source of Drug Coverage, 2006

NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

(Among Seniors Taking 1 or More Rx)

Chart 12

7%

10%

14%

8%

11%

8%

11%11% *

8% *

5% *

7% *

5% *



Share of Seniors Spending More Than $300 Per Month on Prescriptions, by Source of Drug Coverage,

2006

NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.


Chart 13

Share of Seniors Who Did Not Fill or Delayed Filling Prescriptions Due to Cost, by Source of Drug

Coverage, 2006

NOTES: “Did not fill/delayed fill of Rx” refers to not filling or delay filling or refilling a prescription because of cost in the past twelve months. VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

16%

21%20%

25%

35% *

23% *

12% *

8% *

16% *

12% *

18% *15% *




Chart 14

2.3

1.81.7

2.3

3.3

2.2

1.61.4

2.0

None Part D Part D None Part D Part D None Part D Part D

Reference Group

Part D Part D Part DEmployer EmployerEmployerVA VAVA

Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-

Adherence, 2006

Spend >$100/month

Spend >$300/month

Did not fill/Delay fill or refill due to cost in past 12 months

Notes: Findings based on three separate models each of which controlled for demographics, health measures, self-reported diseases, number of duals, and source of coverage. Among seniors taking one or more prescription medications. VA is Department of Veterans Affairs. Numbers are rounded.

Source of Coverage

vs. vs. vs. vs. vs. vs. vs. vs. vs. vs.

(Odds Ratios)

SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Dugs, 2006.

Chart 15

Share of Seniors Who Purchased Prescriptions From Canada or Mexico, by Source of Drug

Coverage, 2006

4%

5%

5%

4%

10% *

2% *

No RxCoverage

Other

VA

Employer

Part D

Total


NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded.

Chart 16


Characteristics and Cost-Related Experiences of Non-

Institutionalized Seniors in Part D Plans

Part D Enrollment Among Non-Institutionalized Seniors, by Plan Type, 2006

30%

70%

Medicare Advantage Prescriptio

n Drug Plan

(MAPD)

Stand-Alone

Prescription Drug

Plan (PDP)


Chart 17

NOTES: Numbers are rounded.

Share of Seniors in Part D Plans (PDP vs. MAPD) with Selected Characteristics, 2006

37%

23%

7%

13%

10%

45%*

31%*

30%*

24%*

12%*

3+ ChronicConditions

7+ Rx

Rurallocation

≤100%Poverty

Age 85+

Stand-AlonePrescription Drug Plan(PDP)Medicare AdvantagePrescription Drug Plan(MAPD)

NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

(per month)

Chart 18

Race/Ethnicity of Seniors in Part D Plans, by Part D Plan Type, 2006

NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

83% 83% 82%

8% 8% 7%6% 8%5% *

Total Stand-AlonePrescription Drug

Plan (PDP)

Medicare AdvantagePrescription Drug

Plan (MAPD)

Nonwhite HispanicAfrican AmericanWhite

Chart 19

22%

7%

21% *

8% *

28% *

17%

Did NotFill/ Delayed Filling

Due to Cost

Spent>$100/ month

Spent>$300/ month

Stand-AlonePrescription DrugPlan (PDP)

MedicareAdvantagePrescription DrugPlan (MAPD)

Prescription Out-of-Pocket Spending and Non-Adherence Among Seniors in Part D Plans, by Part

D Plan Type, 2006

NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.


Chart 20

Role of the Part D Low-Income Subsidy (LIS) and Non-

Institutionalized Seniors’ Related Experiences

Drug Coverage Among Seniors with Incomes At or Below 150% of Poverty Who Were Not Receiving

the Low-Income Subsidy (LIS), 2006

16%

14%

23%

48%

Part D

Employer/ VA

Other

No Rx Coverage


NOTES: VA is Department of Veterans Affairs. Numbers are rounded.

Chart 21

Characteristics of Seniors in Part D Plans, With Incomes At or Below 150% of Poverty, With and

Without the Low-Income Subsidy (LIS), 2006

42%

26%

28%

70%

14%

54%

37%

32%

78%

18%

3+ ChronicConditions

7+ Rx

Rural Location

Female

Age 85+

With LISWithout LIS

NOTES: Weighted percentages. Excludes dual eligibles and seniors for whom LIS status is unknown (n=686). Significance testing: with LIS versus without LIS (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

(per month)

Chart 22

Out-of-Pocket Spending on Prescriptions and Non-Adherence Among Low-Income Seniors in Part D Plans, With and Without the Low-Income Subsidy (LIS), 2006

32%

9%

22%

4% *

11% *

27%

Did Not Fill/ DelayedFilling Due to Cost

Spent >$100/ month Spent >$300/ month

Without LISWith LIS

NOTES: Weighted percentages. Excludes dual eligibles and seniors for whom LIS status is unknown (n=686). Significance testing: with LIS versus without LIS (*p < 0.05). Low-income is defined as at or below 150% of poverty. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.


Chart 23

Share of Seniors With Incomes At or Below 150% of Poverty Who Said That They Were Not Aware of the Part D Low-Income

Subsidy (LIS), Among Those Not Receiving The LIS, 2006

43%

48%

46%

65% *

65% *

50% *53% *

Total

135% - 150%

101% - 134%

≤100%

Hispanic

African American

White

% Poverty

Race/Ethnicity

NOTES: Weighted percentages. Reference Groups: 135-150% of poverty, white, and Part D Rx Coverage (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.

Chart 24

Cost-Related Experiences of Non-Institutionalized Seniors in Part D Plans, by Income and Low-Income

Subsidy (LIS) Status

Seniors in Part D Plans Who Spent More Than $100 Per Month on Prescriptions, by Income Level and

Low-Income Subsidy (LIS) Status, 2006

26%

32%35%

33%

11% *7% *

Total PartD

DualEligibles

<150%PovertyWith LIS

<150%PovertyWithout

LIS

151-200%

Poverty

>200%Poverty

NOTES: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group, except as indicated (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.


Chart 25

Seniors in Part D Plans Who Spent More Than $300 Per Month on Prescriptions, by Income Level and

Low-Income Subsidy (LIS) Status, 2006

8%9%

11%

10%

4%*

2%*

Total PartD

DualEligibles


<150%PovertyWithout

LIS

151-200%Poverty

>200%Poverty

NOTES: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group, except as indicated (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.


Chart 26

Seniors in Part D Plans Who Did Not Fill or Delayed Filling a Prescription Due to Costs in the Past Twelve

Months, by Income Level and Low-Income Subsidy (LIS) Status, 2006

20%

15%

26%*27%*

22%*20%*

Total PartD

DualEligibles


<150%PovertyWithout

LIS

151-200%Poverty

>200%Poverty

NOTE: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.


Chart 27

8%

11%

8%

13%

8%7%

8% 8%6%

10%

20%*

11%*

Changed Part D Plans Needed Permission to Fill Rx

Total Dual Eligibles ≤150% FPL w/ LIS ≤150% FPL w/out LIS 151-200% FPL >200% FPL

Part D Enrollees’ Experiences Since Enrolling in a Part D Plan, by Income Level and Low-Income Subsidy (LIS)

Status, 2006


NOTE: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level (FPL): $9,800/individual and $13,200/couple. Numbers are rounded.


Chart 28

15%

21%

13%*

15%*

9%*

6%*

Total Part D DualEligibles

<150%Povertywith LIS

<150%Poverty

without LIS

151-200%Poverty

>200%Poverty

Share of Part D Enrollees’ Who Started Ordering Prescriptions by Mail, by Income Level and Low-

Income Subsidy (LIS) Status, 2006


NOTE: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded.


Chart 29

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