Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115507

Donald S. Shepard, PhD¹, Musetta Leung, MS¹, William B. Stason, MD¹, Grant A. Ritter, PhD², and Cindy Parks Thomas, PA, PhD³. (1) Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110, 781-736-3975, Shepard@Brandeis.edu, (2) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110, (3) Schneider Institute for Health Policy, Brandeis University, Heller School for Social Policy and Management, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110

In mid-2002, Illinois and Wisconsin initiated “SeniorCare” (SC) pharmacy assistance programs (PAPs) that provide low-income persons aged 65+ with publicly funded prescription drug assistance. Maximum co-payments per prescription are generally $4 in IL and $15 in WI. Enrollees with incomes up to 200% of the federal poverty limit (FPL) are funded under a Medicaid waiver designed to help seniors improve prescription drug use, maintain health and reduce financial vulnerability due to prescription costs. Key measures of vulnerability were “going without necessities” and “skimping” (not filling all prescribed medications or skipping some doses for financial reasons). In spring 2004, a stratified random sample of 2227 of the 237,000 enrollees was surveyed to assess reductions in vulnerability from the 6 months prior to joining SC to the latest 6 months in SC and other outcomes. The survey also contrasted impacts among three groups—WI enrollees (all new to a PAP), Illinois “rollovers” automatically rolled in SC from a limited PAP that excluded mental health and gastro-intestinal drugs, and IL “new” members (those not previously in the limited PAP). The response rate was 61%. With an average age of 77 years, respondents were mostly female (73%), white (83%), had household incomes below 160% of the FPL (66%), and lived alone (53%). The proportion of seniors going without some necessities was cut in half from 35.4% before SC to 17.0% after SC. The overall share of skimping was 28.4% before SC and 12.9% after SC, representing a proportional reduction of 55%. As expected, before SC, IL rollovers were significantly less likely to skimp than IL new enrollees (27.1% vs. 36.7%) but IL rollovers still improved significantly and achieved comparable levels to IL new after SC (15.4% vs. 14.8%, respectively). When respondents were categorized by demographic and health factors into tertiles of pre-SC risk of skimping, the 3 groups achieved proportional reductions in skimping of 46% to 63%. The absolute improvement in skimping, however, was greatest in the highest tertile. While skimping in the lowest tertile fell from 14.4% to 7.8%, it declined from 45.5% to 17.0% in the highest tertile. The absolute differences of 6.6 and 28.5 percentage-points, respectively, mean that SC averted skimping for only 1 in 15 low-risk enrollees, but for 2 out of 7 high-risk enrollees. Thus the two state PAPs studied here cut financial vulnerability by more than half, and those at greatest risk of skimping benefited the most.

Learning Objectives: