1 The opinions presented here are those of the authors and may not represent the views or policies of the Centers for Medicare & Medicaid Services Medicare.

1

The opinions presented here are those of the authors and may not represent the views or policies of the Centers for Medicare & Medicaid

Services

Medicare Beneficiary Knowledge of, Awareness of, and Experience with Prescription Drug Discount Cards

Noemi V. Rudolph, MPH and Sunyna S. Williams, PhDCenters for Medicare & Medicaid Services

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Acknowledgements

• CMS: Brigid Goody, Frank Eppig, Gerald Riley, Gerald Adler

• RTI International• Westat: Eileen Horan

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Introduction

• In anticipation of the Medicare Prescription Drug Coverage Program, we sought to understand beneficiary experiences and knowledge of prescription drug discount cards

• Baseline information prior to any Medicare-sponsored card, follow-up one-year later with information about Medicare-approved drug cards

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Data

• Medicare Current Beneficiary Survey (MCBS) – nationally representative sample of Medicare beneficiaries; continuous, multipurpose, include topical supplements

• Questionnaire Item Development - Questions in Discount Awareness (DA) Supplement were developed and cognitively tested; examined perceived and demonstrated knowledge about, sources of information for, experience and satisfaction with their drug discount card(s); questions for MA supplement were derived from DA supplement, but changed as needed to focus on Medicare-approved drug discount cards

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Data

• Sample: community dwelling, non-institutionalized, proxies allowedDA Supplement – May through August 2004, n=13,344MA Supplement – May through August 2005, n=10,917; focused questions on MA drug cards, excludes beneficiaries with full MedicaidLinked dataset – capture respondents who were part of both DA and MA supplement, n=7,572

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Variables

• Demographics and insurance: socio-demographics, health status, Medicare health insurance category, drug coverage

• Drug card: perceived drug card knowledge, drug card knowledge score, whether sought information about drug cards, done anything to reduce cost of drugs

• Medicare knowledge: understandability of the Medicare program, global perceived Medicare program knowledge, Medicare knowledge quiz, whether make own health decisions

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Analyses

• Descriptive: weighted percentages of card awareness, information seeking behavior, cost-reduction strategies, card experiences, overall satisfaction, expected savings, reasons for no current card, transitional assistance

• Comparisons between cardholders and non-cardholders: general linear model analyses accounting for complex sample design

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Analyses (cont)

• Predictions of knowledge: simple linear regression to get individual factors associated with DA or MA knowledge, then backward elimination multiple regressions to arrive at the final models

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Perceived Knowledge & Information Seeking Behavior

• 60% perceived they knew nothing or almost nothing about DA drug cards, 56% for MA drug cards

• 16-17% sought information about DA and MA drug cards

• Sources of information: pharmacists, Medicare (1-800-MEDICARE, brochures, pamphlet from Medicare), AARP and other senior organizations

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Percent of DA and MA Cardholders

• 2003: 9% had DA card2004: 8% had DA card only; 2% had MA

card only, 4% had both• In 2004, those who had one type of card

were significantly more likely to have the other type of card (32% of DA cardholders compared to 2% of DA non-cardholders were also MA cardholders)

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Card Experiences

Overall Satisfaction

DA MA

Very satisfied

38.4 35.0

Satisfied 47.1 42.6

Dissatisfied 10.4 16.9

Very dissatisfied

4.2 5.6

Savings Expectations

DA MA

More than expected

25.7

36.7

About as much as exp

48.0

36.2

Less than expected

26.3

27.1

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Card Experiences (cont)

How often use card to buy Rx drugs?

DA MA

All of the time 68.3 77.6

Most of the time

11.6 10.6

Some of the time

20.1 11.9

How many Rx does card cover?

DA MA

All of the presc

45.1 54.3

Most of the presc

16.0 22

Some of the presc

37.1 21.2

None of the presc

1.7 2.4

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Card Experiences (cont)

Easy understand which pharmacies accept card?

DA MA

Very easy 44.9 53.4

Somewhat easy 39.5 38.3

Somewhat difficult

12.1 7.1

Very difficult 3.5 1.1

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Reasons for not having card

DA MA

Already had presc coverage 35.9 34.9

Savings amount not worth it 22.9 27.3

Signing up was too confusing 15.9 13.1

Can’t find/didn’t have info 13.3 14.4

Cost to join/cost too much to join

7.7 5.5

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Cost-reduction strategies

DA MA

Requested generic 52.2 49.6

Got samples from doctor 39.5 18.1

Purchased through mail 18.1 24

Took less medicine 10 6

Skipped doses 7.9 5.2

Bought Rx outside US 5.4 2.7

Purchased through internet 2 2

Shared medicine 1.6 0.9

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DA Cardholders vs. Non-cardholders

• DA cardholders more likely to be older seniors, female, white, widowed, lower income, more chronic conditions, have no other drug coverage, more likely to be those with Original Medicare with and without supplement, have greater perceived knowledge about drug cards, more likely to have sought information, have done something to reduce cost of drugs, have higher DA drug card knowledge

• No differences: education, perceived health status, understandability of Medicare, perceived Medicare knowledge

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MA Cardholders vs. Non-cardholders

• Similar findings to DA analysis except:- MA cardholders less likely to be educated, to be married, lower perceived health status, have Original Medicare plus supplement or managed care, more likely to have Original Medicare or dual eligible - No significant differences in age, race

• Some of the demographic and insurance differences between DA and MA findings likely due to exclusion of full duals in MA supplement

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DA Card Knowledge

• Factors associated with higher DA card knowledge:- some college education and beyond- income >$25K- higher perceived health status- current cardholder- higher perceived knowledge about drug cards- tried to find information about drug cards- did something to reduce the cost of drugs- higher score on Medicare knowledge items

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DA Card Knowledge

• Factors associated with lower levels of knowledge:- age 65 and over- race of Black or Other- female- widowed- never married- Medicare managed care- dual eligible

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MA Card Knowledge

• Factors associated with higher MA card knowledge:

- age 75-84- some college education- income >$25K- current cardholder- higher perceived knowledge about MA cards- tried to find information about MA cards- did something to reduce the cost of drugs- higher score on Medicare knowledge items

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MA Card Knowledge

• Factors associated with lower MA card knowledge:- age 85+- race of Black or Other- have drug coverage- understandability about the Medicare program

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TA Subanalyses

• Approx. 65% of MA cardholders did not apply for TA

• Reasons did not apply- Not/not think eligible 60.5%- Didn’t know how to apply 21.9- Doesn’t need due to other cov 10.9- Didn’t understand application info 7.6- Automatically enrolled by state 5.6- Not worth the trouble 1.9- Other 1.7

• Those with TA more satisfied and saved more than expected

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Conclusions

• Beneficiary perceived knowledge of prescription drug discount cards (general and Medicare-approved) were low and few were interested in more information.

• DA/MA cardholders (vs. non-cardholders) more likely to be female, widowed, low income, more chronic conditions, no other drug coverage, greater perceived knowledge, sought information, done something to reduce the cost of drugs, and higher knowledge quiz scores; no differences in perceived health status, making own health decisions, understandability of Medicare and perceived Medicare knowledge

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Conclusions

• Factors associated with higher card knowledge include college education, income>$25K, cardholder, higher perceived knowledge about drug cards, tried to find info about cards, did something to reduce cost of drugs, and high Medicare quiz score. Factors associated with lower card knowledge include age and race.

• Understanding of factors associated with knowledge of, awareness of, and experiences with prescription drug discount cards can help CMS better target their educational efforts for the Medicare Prescription Drug Coverage Program