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Medicare Prescription Drug Benefit Progress Report:
Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors and Prescription Drugs
August 2007
The National Survey of Seniors and Prescription Drugs, 2006 was designed and analyzed by researchers at the Kaiser Family Foundation, The Commonwealth Fund, and Tufts–New England Medical Center. The survey of 16,072 seniors was administered in English and Spanish between October 5 and December 20, 2006, primarily by mail with telephone follow-up. The study used an augmented longitudinal design that included respondents to our 2003 national survey of seniors and a randomly selected nationally representative sample of non-institutionalized Medicare beneficiaries age 65 and older that was provided by the Centers for Medicare and Medicaid Services in June 2006. After accounting for beneficiaries excluded because of death, institutionalization, relocation, non-English/Spanish language, or severe cognitive or physical impairment, the final study sample had a response rate of 56 percent. The survey had a margin of sampling error of less than 1 percent. Bivariate and multivariate methods were used to examine seniors’ prescription drug coverage, use, out-of-pocket spending, adherence, and experiences in a Part D plan.
Methodology
Prescription Drug Coverage of Non-Institutionalized Seniors
Share of Non-Institutionalized Seniors Who Said They Were Without Drug Coverage in 2005 and
2006
33%
8%
2005 2006
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 1
NOTES: Numbers are rounded.
Distribution of Non-Institutionalized Seniors’ Drug Coverage in 2006 Among Those Who Did Not Have Drug Coverage in
2005
67% 33%
YesNo
61%
7%
5%
20%
7%
Drug coverage in 2005:
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Source of Drug Coverage in 2006:
No Rx Coverage
Other
Part D
VAEmployer
NOTES: VA is Department of Veterans Affairs. Numbers are rounded.
Chart 2
3%
8%
7%
31%
50%
Part D
Employer
VA
Other Coverage
None
Distribution of Non-Institutionalized Seniors by Primary Source of Drug Coverage, 2006
NOTES: VA is Department of Veterans Affairs. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 3
40%
48%
66%*
54%*
54%*
62%*
50%*
63%*
74%*
41%
Part D Coverage Rates Among Seniors with Selected Characteristics, 2006
NOTES: Weighted percentages. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Reference groups for statistical significance include: white, >200% poverty, and no chronic conditions (*p < 0.05). Numbers are rounded.
Total
WhiteAfrican American
Hispanic
<100%101-150%
151-200%
>200%
1 or 2
3 or more
None
Race/Ethnicity
% Poverty
Chronic Conditions
50%
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 4
7%
10%
5%
8%
12%
7%
11%
8%
14%
23%
8%
8%
10%
Lack of Any Drug Coverage Among Seniors with Selected Characteristics, 2006
Total
WhiteAfrican American
Hispanic
<100%101-150%
151-200%
>200%
1 or 2
3 or more
None
Race/Ethnicity
% Poverty
Chronic Conditions
Rural
Urban
Urban/Rural Location *
*
*
*
*
*
NOTES: Weighted percentages. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Reference groups for statistical significance include: white, >200% poverty, and no chronic conditions (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 5
Seniors’ Drug Coverage in Selected States, 2006
8% 10% 7% 8% 10% 9% 8%
7% 8% 8%3%
4%
3%2%
4%
3% 4%
31%34%
33%
50% 49% 52% 50%
6%*
6%*11%*
13%*5%*
4%*2%*
24%*23%*36%*
35%*
21%*
57%*46%*44%*
63%*
Total CA FL NY OH PA TX 7 StateRural
Region
Part D
Employer
VA
Other
No Rx Coverage
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
NOTES: VA is Department of Veterans Affairs. Seven state rural region includes: IA, MN, MT, ND, NE, SD, WY. Reference group for statistical significance is Total (*p<0.05). Numbers are rounded.
Chart 6
Low-Income Seniors’ Drug Coverage in Selected States, 2006
12% 15% 11% 12% 16% 13% 10%
8%6%
9% 6% 7%
2% 2% 3%1% 2%
3%
2% 2%
10%10%
10%
10%
12%6%
68% 71%66% 68%
7%*
13%*
16%*3%*
21%*
4%*
74%*
58%*57%*
77%*
Total CA FL NY OH PA TX 7 StateRural
Region
Part D
Employer
VA
Other
No Rx Coverage
NOTES: VA is Department of Veterans Affairs. Seven state rural region includes: IA, MN, MT, ND, NE, SD, WY. Low-income refers to seniors at or below 150% of poverty. Reference group for statistical significance is Total (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 7
Characteristics of Non-Institutionalized Seniors with
Various Sources of Drug Coverage
21% 23%
23%
9%
2%*8%*
23%
8%*
17%*
11%
9%*
18%*
46%
82%*
57%45%
Part D Employer VA None
>200% FPL
150-200% FPL
101-150% FPL
<100% FPL
Income Distribution of Non-Institutionalized Seniors, by Source of Drug Coverage, 2006
NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. In 2006, federal poverty level (FPL): $9,800/individual and $13,200/couple. The reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 8
81%
5%3% 1%3%
6%
2%*3%*
6%
8%
3%*
4%*
8%
95%*90%*
83%
Part D Employer VA None
White
African American
Hispanic
Asian/ Other
Race/Ethnicity of Non-Institutionalized Seniors, by Source of Drug Coverage, 2006
NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D Coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 9
29%33%*21%*24%
71%*68%*79%*76%
Part D Employer VA None
Urban
Rural
Rural/Urban Residence of Non-Institutionalized Seniors, by Source of Drug Coverage, 2006
NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 10
9% 10%
21% 21%14%
45% 45%
25% 25%
30%*
7%
26%*48%
32%*
12%*
31%*
Part D Employer VA None
7 or more3 to 61 or 2None
Number of Prescriptions Taken Monthly by Non-Institutionalized Seniors, by Source of Drug
Coverage, 2006
NOTES: VA is Department of Veterans Affairs. "Other coverage" is not shown. Reference group for statistical significance is Part D coverage (*p < 0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 11
Prescription Drug Use, Out-of-Pocket Spending, and Non-
Adherence
4.9
6.3
5.0
6.3
5.0
6.5 6.5
5.6*
4.0*
5.6* 5.8*
4.7*
All Seniors Seniors with 3+ ChronicConditions
Total No Rx Coverage Part D Employer VA Other
Mean Number of Prescriptions Filled by Seniors Per Month, by Source of Drug Coverage, 2006
NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(Among Seniors Taking 1 or More Rx)
Chart 12
7%
10%
14%
8%
11%
8%
11%11% *
8% *
5% *
7% *
5% *
All Seniors Seniors with 3+ ChronicConditions
Total No Rx Coverage Part D Employer VA Other
Share of Seniors Spending More Than $300 Per Month on Prescriptions, by Source of Drug Coverage,
2006
NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(Among Seniors Taking 1 or More Rx)
Chart 13
Share of Seniors Who Did Not Fill or Delayed Filling Prescriptions Due to Cost, by Source of Drug
Coverage, 2006
NOTES: “Did not fill/delayed fill of Rx” refers to not filling or delay filling or refilling a prescription because of cost in the past twelve months. VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
16%
21%20%
25%
35% *
23% *
12% *
8% *
16% *
12% *
18% *15% *
All Seniors Seniors with 3+ ChronicConditions
Total No Rx Coverage Part D Employer VA Other
(Among Seniors Taking 1 or More Rx)
Chart 14
2.3
1.81.7
2.3
3.3
2.2
1.61.4
2.0
None Part D Part D None Part D Part D None Part D Part D
Reference Group
Part D Part D Part DEmployer EmployerEmployerVA VAVA
Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-
Adherence, 2006
Spend >$100/month
Spend >$300/month
Did not fill/Delay fill or refill due to cost in past 12 months
Notes: Findings based on three separate models each of which controlled for demographics, health measures, self-reported diseases, number of duals, and source of coverage. Among seniors taking one or more prescription medications. VA is Department of Veterans Affairs. Numbers are rounded.
Source of Coverage
vs. vs. vs. vs. vs. vs. vs. vs. vs. vs.
(Odds Ratios)
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Dugs, 2006.
Chart 15
Share of Seniors Who Purchased Prescriptions From Canada or Mexico, by Source of Drug
Coverage, 2006
4%
5%
5%
4%
10% *
2% *
No RxCoverage
Other
VA
Employer
Part D
Total
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
NOTES: VA is Department of Veterans Affairs. Reference group for statistical significance is Part D coverage (*p<0.05). Numbers are rounded.
Chart 16
(Among Seniors Taking 1 or More Rx)
Characteristics and Cost-Related Experiences of Non-
Institutionalized Seniors in Part D Plans
Part D Enrollment Among Non-Institutionalized Seniors, by Plan Type, 2006
30%
70%
Medicare Advantage Prescriptio
n Drug Plan
(MAPD)
Stand-Alone
Prescription Drug
Plan (PDP)
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 17
NOTES: Numbers are rounded.
Share of Seniors in Part D Plans (PDP vs. MAPD) with Selected Characteristics, 2006
37%
23%
7%
13%
10%
45%*
31%*
30%*
24%*
12%*
3+ ChronicConditions
7+ Rx
Rurallocation
≤100%Poverty
Age 85+
Stand-AlonePrescription Drug Plan(PDP)Medicare AdvantagePrescription Drug Plan(MAPD)
NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(per month)
Chart 18
Race/Ethnicity of Seniors in Part D Plans, by Part D Plan Type, 2006
NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
83% 83% 82%
8% 8% 7%6% 8%5% *
Total Stand-AlonePrescription Drug
Plan (PDP)
Medicare AdvantagePrescription Drug
Plan (MAPD)
Nonwhite HispanicAfrican AmericanWhite
Chart 19
22%
7%
21% *
8% *
28% *
17%
Did NotFill/ Delayed Filling
Due to Cost
Spent>$100/ month
Spent>$300/ month
Stand-AlonePrescription DrugPlan (PDP)
MedicareAdvantagePrescription DrugPlan (MAPD)
Prescription Out-of-Pocket Spending and Non-Adherence Among Seniors in Part D Plans, by Part
D Plan Type, 2006
NOTES: Weighted percentages. Significance testing: PDP versus MAPD plan (*p<0.05). Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(Among Seniors Taking 1 or More Rx)
Chart 20
Role of the Part D Low-Income Subsidy (LIS) and Non-
Institutionalized Seniors’ Related Experiences
Drug Coverage Among Seniors with Incomes At or Below 150% of Poverty Who Were Not Receiving
the Low-Income Subsidy (LIS), 2006
16%
14%
23%
48%
Part D
Employer/ VA
Other
No Rx Coverage
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
NOTES: VA is Department of Veterans Affairs. Numbers are rounded.
Chart 21
Characteristics of Seniors in Part D Plans, With Incomes At or Below 150% of Poverty, With and
Without the Low-Income Subsidy (LIS), 2006
42%
26%
28%
70%
14%
54%
37%
32%
78%
18%
3+ ChronicConditions
7+ Rx
Rural Location
Female
Age 85+
With LISWithout LIS
NOTES: Weighted percentages. Excludes dual eligibles and seniors for whom LIS status is unknown (n=686). Significance testing: with LIS versus without LIS (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(per month)
Chart 22
Out-of-Pocket Spending on Prescriptions and Non-Adherence Among Low-Income Seniors in Part D Plans, With and Without the Low-Income Subsidy (LIS), 2006
32%
9%
22%
4% *
11% *
27%
Did Not Fill/ DelayedFilling Due to Cost
Spent >$100/ month Spent >$300/ month
Without LISWith LIS
NOTES: Weighted percentages. Excludes dual eligibles and seniors for whom LIS status is unknown (n=686). Significance testing: with LIS versus without LIS (*p < 0.05). Low-income is defined as at or below 150% of poverty. In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(Among Seniors Taking 1 or More Rx)
Chart 23
Share of Seniors With Incomes At or Below 150% of Poverty Who Said That They Were Not Aware of the Part D Low-Income
Subsidy (LIS), Among Those Not Receiving The LIS, 2006
43%
48%
46%
65% *
65% *
50% *53% *
Total
135% - 150%
101% - 134%
≤100%
Hispanic
African American
White
% Poverty
Race/Ethnicity
NOTES: Weighted percentages. Reference Groups: 135-150% of poverty, white, and Part D Rx Coverage (*p<0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
Chart 24
Cost-Related Experiences of Non-Institutionalized Seniors in Part D Plans, by Income and Low-Income
Subsidy (LIS) Status
Seniors in Part D Plans Who Spent More Than $100 Per Month on Prescriptions, by Income Level and
Low-Income Subsidy (LIS) Status, 2006
26%
32%35%
33%
11% *7% *
Total PartD
DualEligibles
<150%PovertyWith LIS
<150%PovertyWithout
LIS
151-200%
Poverty
>200%Poverty
NOTES: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group, except as indicated (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(Among Seniors Taking 1 or More Rx)
Chart 25
Seniors in Part D Plans Who Spent More Than $300 Per Month on Prescriptions, by Income Level and
Low-Income Subsidy (LIS) Status, 2006
8%9%
11%
10%
4%*
2%*
Total PartD
DualEligibles
<150%PovertyWith LIS
<150%PovertyWithout
LIS
151-200%Poverty
>200%Poverty
NOTES: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group, except as indicated (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(Among Seniors Taking 1 or More Rx)
Chart 26
Seniors in Part D Plans Who Did Not Fill or Delayed Filling a Prescription Due to Costs in the Past Twelve
Months, by Income Level and Low-Income Subsidy (LIS) Status, 2006
20%
15%
26%*27%*
22%*20%*
Total PartD
DualEligibles
<150%PovertyWith LIS
<150%PovertyWithout
LIS
151-200%Poverty
>200%Poverty
NOTE: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
(Among Seniors Taking 1 or More Rx)
Chart 27
8%
11%
8%
13%
8%7%
8% 8%6%
10%
20%*
11%*
Changed Part D Plans Needed Permission to Fill Rx
Total Dual Eligibles ≤150% FPL w/ LIS ≤150% FPL w/out LIS 151-200% FPL >200% FPL
Part D Enrollees’ Experiences Since Enrolling in a Part D Plan, by Income Level and Low-Income Subsidy (LIS)
Status, 2006
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
NOTE: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level (FPL): $9,800/individual and $13,200/couple. Numbers are rounded.
(Among Seniors Taking 1 or More Rx)
Chart 28
15%
21%
13%*
15%*
9%*
6%*
Total Part D DualEligibles
<150%Povertywith LIS
<150%Poverty
without LIS
151-200%Poverty
>200%Poverty
Share of Part D Enrollees’ Who Started Ordering Prescriptions by Mail, by Income Level and Low-
Income Subsidy (LIS) Status, 2006
SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, 2006.
NOTE: Weighted percentages. Excludes seniors for whom LIS status is unknown (n=686). Significance testing: >200% poverty as reference group (*p < 0.05). In 2006, federal poverty level: $9,800/individual and $13,200/couple. Numbers are rounded.
(Among Seniors Taking 1 or More Rx)
Chart 29