The Demise of Oregon's Medically Needy Program: Effects of Losing Prescription Drug Coverage and Pha

1
The Demise of Oregon's Medically Needy Program
Effects of Losing Prescription Drug Coverage and
Pharmaceutical Company Drug Assistance Programs

• Judy Zerzan, MD, MPH
• Oregon Health Science University
• Funded by a RWJ State Coverage Initiatives Grant
• Office of Oregon Health Policy and Research

2
Medically Needy Program

• Optional federally-matched Medicaid program
• 34 states offer
• Coverage for people with high medical expenses
  not qualified for Medicaid
• Eligibility determined by
• Net monthly income after medical expenses
• State established income limit
• Oregon 413

3
Oregons Medically Needy Program

• Covered 8,750 people
• 69 adults ages 19-65 with disabilities
• 31 adults over 65
• Covered
• Prescription drugs
• Limited mental health services
• Limited medical transportation
• Program terminated Jan. 31, 2003
• State policymakers interested in impact

4
Objectives

• Conducted 6 months after program end
• Describe population and use of prescription drugs
  
• Investigate changes
• Health status
• Financial impact
• ER visits and hospitalizations

5
Methods

• Developed and piloted 49-item survey
• Phone survey conducted in August 2003 (6 months
  after end of program)
• Random state-wide sample of 1,269
• 725 wrong numbers and non-contacts
• 439 respondents
• 105 refusals
• Adequately powered to detect difference in
  utilization

6
Characteristics of Participants

• 64 women
• Average age 58 years (range 22-91)
• Predominantly white (92)
• 95 unemployed
• 85 gross income levels lt15,000 per year (2002)

7
Health Insurance

• 92 covered by Medicare
• 21 covered by other health insurance
• 4.6 had prescription drug benefits

8
Current Overall Health
9
Chronic Medical Problems
Average 3.5 Chronic Medical Conditions
(Range 0-25)
10
Most Commonly Used Drug Classes
Average 5.5 prescriptions per month (Range 0-27)
11
Primary Method of Payment for Prescriptions
Before
After
100 Medically Needy Program
Drug Company Assist Program 29
12
Average Monthly Out-of-Pocket Drug Costs

• Average monthly out-of-pocket costs 100-199
• Average drug costs 1200-2388 / year
• Average income 5000-9999 / year
• Spend 24-48 of income on rx drugs
• At time of survey 49 skipping drugs

13
Percentage Not Filling a Prescription by Monthly
Out-of-Pocket Prescription Expenses(6 months)
14
Financial Impact (6 months)

• To pay for medications
• 60 cut back on their food budget
• 49 skipped paying bills or paid bills late
• 48 borrowed money from family/friends
• 21 added credit card debt

15
Health Status Compared to One Year Ago
16
Healthcare Utilization6 months before/after end
of MN program(self-report)
Total Number
p0.04
17
Drug Company Patient Assistance Programs

• 45 currently use
• 68 get assistance filling out paperwork
• primarily from a doctors office or clinic
• 55 report using these programs is very or
  somewhat hard to do

18
Drug Company Patient Assistance Programs (45 use)

• 37 get only some of their drugs
• Mostly not all of their medications are covered
• 39 of people are very or somewhat confident they
  can continue to use
• 52 are not very or not at all confident

19
NOT Using Drug Company Assistance Programs (55)

• 2/3 applied for these programs in the past
• 41 approved in the past
• 29 waiting to hear
• 6 refused
• 8 didnt finish the paperwork
• 1/3 who have not applied give the following
  reasons
• dont know much about
• can afford some prescriptions
• too much hassle
• need assistance with the paperwork
• arent available of the drugs they need

20
Limitations

• Descriptive study
• Sample bias
• English
• Telephone households
• Non-responders and wrong numbers
• Recall bias due to self-reported data
• Did not capture complexity of all impact on
  medication use
• Did not include long-term health outcomes

21
Conclusions Loss of Medically Needy Program

• Oregonians affected
• Unemployed, income under 15,000/yr adults
• 92 covered by Medicare
• Average of 3.5 chronic medical problems
• Average of 5.5 prescription drugs a month
• Found
• Patients taking less of their medications
• Financial impact in the daily life of patients
• Worsening health status
• No increase in ER visits and hospitalizations
• Pharmaceutical company assistance programs are
  not enough

22
Discussion

• No increase in ER visits and hospitalizations
• 6 months too soon
• Types of diseases
• Spreading out medication use
• Raw data shows may be less surgeries
• Selection bias did not contact sicker
• Avoiding further financial impact

23
Implications

• Medically Needy population is vulnerable and at
  risk of further worsening of health
• Losing drug benefits has immediate impact on drug
  use and finances
• National changes
• Medically Needy programs
• Medicaid funding and benefits
• Medicare Rx benefit
• Pharmaceutical company drug assistance programs
  do not fill the gap
• Need longer term study

24
Thanks to Tina Edlund, Lisa Krois and Jeanene
Smith from Office for Oregon Health Policy and
Research Dan Touchette and Dean Haxby from OHSU