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More Than 1 in 4 Medicaid Beneficiaries Can't Afford Prescription Drugs
National Study Indicates State Medicaid Cost-Containment Policies Curtail Access to Drugs
FURTHER INFORMATION, CONTACT:
ASHINGTON, D.C.—Medicaid beneficiaries in states trying more aggressively to contain escalating prescription drug spending are twice as likely to report they cant afford medications as people in states with less stringent policies, according to a national study released today by the Center for Studying Health System Change (HSC).
Although all states offer prescription drug coverage for most Medicaid beneficiaries, 26 percent of Medicaid beneficiaries aged 18 to 64 said they couldnt afford to get a prescription filled in the previous year, according to findings from HSCs 2000-01 Community Tracking Study Household Survey, a nationally representative survey involving about 60,000 people in 33,000 families. Medicaid is the joint federal-state program that provides health care coverage to about 37.8 million low-income and disabled people of all ages.
"The findings are surprising because Medicaid is expected to ensure access to affordable care for the poorest and sickest Americans," said Len Nichols, Ph.D, vice president of HSC, a nonpartisan policy research organization funded by The Robert Wood Johnson Foundation. "The study raises serious questions about the impact of state efforts to control Medicaid drug spending."
The prescription drug access problems experienced by Medicaid beneficiaries are virtually the same as the uninsured—26 percent vs. 29 percent. In contrast, only 8 percent of people with employer-sponsored coverage said they couldnt afford a prescribed drug in the previous year. Similarly, only 8 percent of elderly Medicare beneficiaries said they couldnt fill a prescription. Medicare, the federal program that provides coverage to the elderly and disabled, does not cover most outpatient prescription drugs, but about two-thirds of Medicare beneficiaries have drug coverage through other sources.
The study findings are detailed in a new HSC Issue Brief—Prescription Drug Access: Not Just a Medicare Problem. A webcast of this briefing will be made available by kaisernetwork.org/healthcast/hsc/09apr02, a free service of the Kaiser Family Foundation, after 3 p.m. EDT on Tuesday, April 9. The webcast, transcript and related resources can be found here.
Although Medicaid cost-containment methods vary from state to state, the most common include imposing nominal copayments, setting dispensing limits that restrict the number of prescriptions, mandating substitution of generic drugs for brand-name drugs, requiring prior authorization requirements for certain drugs and issuing step-therapy protocols that require physicians to try lower-cost drugs before prescribing more costly alternatives.
Individual cost-containment techniques had little impact on Medicaid beneficiaries access to prescription drugs, but multiple cost-containment methods affected access to prescription drugs to a much greater extent. Medicaid beneficiaries aged 18 to 64 in states with four or five cost-containment measures were about twice as likely to report cost barriers as those living in states with either one or no cost-containment policies, the study found.
"An unintended consequence of aggressive state cost-containment policies might be reduced Medicaid beneficiary access to needed prescription drugs," said Peter J. Cunningham, Ph.D., a senior HSC health researcher and author of the study.
Medicaid beneficiaries lower incomes and poorer health compound the problems they have affording prescription drugs. Half of Medicaid beneficiaries aged 18 to 64 have incomes below the federal poverty level, or $8,590 for a single person in 2001, while three-quarters have incomes below 200 percent of poverty. In comparison, 3 percent of people with employer coverage have incomes below poverty and 14 percent have incomes below 200 percent of poverty.
More than half of Medicaid beneficiaries aged 18 to 64 have at least one chronic condition, such as diabetes, heart disease or depression, while less than one-third of people with employer coverage have a chronic condition. More than 40 percent of Medicaid beneficiaries with two or more chronic conditions reported they couldnt afford to fill a prescription.
Many states are facing budget shortfalls, and state officials often point to increased Medicaid spending, especially for prescription drugs, as a significant cause of the shortfalls, along with decreasing state revenues.
"While many private insurers use similar cost-containment methods, policy makers should keep in mind that aggressive cost-containment policies are likely to have a greater impact on Medicaid beneficiaries because they have poorer health and lower incomes than privately insured people," Nichols said.
Joan Henneberry, director of health policy studies division, National Governors Association, www.nga.org
Ron Pollack, executive director, Families USA, www.familiesusa.org
Leighton Ku, Ph.D., senior health policy fellow, Center on Budget and Policy Priorities, www.cbpp.org
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded by The Robert Wood Johnson Foundation and affiliated with Mathematica Policy Research, Inc.