The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70398

Stephen D. Hooper, MBA, Health Economics Group, Inc., 1050 University Avenue, Suite A, Rochester, NY 14607, 585-241-9500, sdh_sdh1@yahoo.com

Discussions of prescription drug coverage under Medicare are based upon limited information because few benefit programs currently offer prescription drug benefits for seniors. For fifteen years a municipality in upstate New York has provided a self-insured prescription drug benefit program for its retirees and their spouses. The benefit plan is generous: patient out-of-pocket costs per prescription are $2.00 or less. This study examined prescription drug utilization and expenditure data from 951 individuals (381 male, 570 female) who were covered continuously from January 1, 1992 through December 31, 2001. In 2001 the median age was 75 years. Average monthly cost per individual was $58.12 in 1992 and $178.26 in 2001. Average cost per prescription increased from $30.91 to $54.35. In the same period, the average number of prescriptions per patient per month also increased: from 1.88 to 3.28. In addition, the Generic fill rate increased from 24% to 45%, without "managed care" intervention. We present and discuss aggregate data as well as differences in utilization and expenditures by gender, on an annual basis as well as for the decade as a whole. During the decade, cost per prescription increased 76% and number of prescriptions per month increased by 74%. Thus, it is our observation that for the Medicare-age population, it is likely that prescriber (physician) practices are as important as are the costs of prescriptions in affecting the overall cost of a prescription drug program.

Learning Objectives:

At the conclusion of the session, the participant (learner) will be able to:
• Describe the trends in prescription drug costs and utilization over a ten year period for a Medicare-age group.
• Describe gender differences in expenditure and utilization patterns.
• Assess the impacts of prescriber behavior (prescriptions written) and drug costs on overall prescription plan costs.

Keywords: Medicaid, Prescription Drug Use Patterns

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am an owner and the president of Health Economics Group, Inc. HEG is a third party administrator and the manager of the prescription benefit program that is the basis of this study.