Promoting access and reducing out-of-pocket prescription drug costs for vulnerable Medicare patients

BACKGROUND: Given the complexity of the Medicare Part D prescription drug benefit and annual plan changes, many Medicare patients often lack knowledge and skills needed to select an optimal Part D plan. This problem is especially prevalent in vulnerable populations, where lack of resources and limited English proficiency are barriers to navigating the benefit effectively. OBJECTIVE: To reach vulnerable Medicare patients and lower their annual out-of-pocket (OOP) prescription drug costs through one-on-one prescription drug plan counseling. METHODS: Students from seven California schools of pharmacy were trained in Part D to provide one-on-one counseling in multiple languages, under faculty supervision. Outreach was targeted toward vulnerable Medicare patients with an annual income less than 300% of the Federal Poverty Level (FPL). Events were conducted in low-income clinics, housing complexes, community centers and other settings serving vulnerable Medicare patients. Annual estimated OOP costs for each participant's current prescription drug plan and the lowest-cost plan (if different) were obtained by entering their current medication regimen online, using the Medicare Prescription Drug Plan Finder tool. Prescription drug cost-related non-adherence behaviors also were identified through a questionnaire. RESULTS: From October 2008 through January 2009, 91 outreach events were conducted and 1,029 low-income (< 300% FPL) patients received one-on-one counseling. Only 27% of patients (n=273) were enrolled in the lowest-cost prescription drug plan. Based on counseling recommendations, 399 patients enrolled in a lower-cost Part D plan, going from a median plan cost of $366.50 to $118.00, for an average OOP cost-savings of 65%. Almost all patients (93%) were receiving governmental assistance with their prescription medication costs; 865 (84%) were from ethnic/racial minority groups; 624 (60%) had limited or no English proficiency; and 488 (47%) did not complete high school. In addition, 51 patients were identified as LIS-eligible and received assistance with their applications during counseling. Of note, 217 (21%) patients reported prescription drug cost-related non-adherence behaviors during the last year, including not filling prescriptions due to cost and/or skipping doses. CONCLUSIONS: Literature suggests that high out-of-pocket drug costs lead to non-adherence behaviors with adverse health consequences. Our findings show that targeted outreach by trained pharmacy advocates can identify vulnerable patient populations in need of Part D counseling and successfully reduce their out-of-pocket prescription drug costs. Our data further show that the majority of vulnerable patients identified in this study is still struggling with medication costs and can maximize their benefit with targeted outreach by trained pharmacy experts.