1. 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, PhD Centers for Medicare & Medicaid Services

2. 2 Acknowledgements CMS: Brigid Goody, Frank Eppig, Gerald Riley, Gerald Adler RTI International Westat: Eileen Horan

3. 3 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

4. 4 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

5. 5 Data Sample: community dwelling, non-institutionalized, proxies allowed DA Supplement – May through August 2004, n=13,344 MA Supplement – May through August 2005, n=10,917; focused questions on MA drug cards, excludes beneficiaries with full Medicaid Linked dataset – capture respondents who were part of both DA and MA supplement, n=7,572

6. 6 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

7. 7 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

8. 8 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

9. 9 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

10. 10 Percent of DA and MA Cardholders 2003: 9% had DA card 2004: 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)

11. 11 Card Experiences Overall Satisfaction DAMA Very satisfied 38.435.0 Satisfied47.142.6 Dissatisfied10.416.9 Very dissatisfied 4.25.6 Savings Expectations DAMA More than expected 25.736.7 About as much as exp 48.036.2 Less than expected 26.327.1

12. 12 Card Experiences (cont) How often use card to buy Rx drugs? DAMA All of the time68.377.6 Most of the time11.610.6 Some of the time 20.111.9 How many Rx does card cover? DAMA All of the presc45.154.3 Most of the presc 16.022 Some of the presc 37.121.2 None of the presc 1.72.4

13. 13 Card Experiences (cont) Easy understand which pharmacies accept card? DAMA Very easy44.953.4 Somewhat easy39.538.3 Somewhat difficult12.17.1 Very difficult3.51.1

14. 14 Reasons for not having card DAMA Already had presc coverage35.934.9 Savings amount not worth it22.927.3 Signing up was too confusing15.913.1 Cant find/didnt have info13.314.4 Cost to join/cost too much to join7.75.5

15. 15 Cost-reduction strategies DAMA Requested generic52.249.6 Got samples from doctor39.518.1 Purchased through mail18.124 Took less medicine106 Skipped doses7.95.2 Bought Rx outside US5.42.7 Purchased through internet22 Shared medicine1.60.9

16. 16 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

17. 17 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

18. 18 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

19. 19 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

20. 20 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

21. 21 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

22. 22 TA Subanalyses Approx. 65% of MA cardholders did not apply for TA Reasons did not apply - Not/not think eligible60.5% - Didnt know how to apply21.9 - Doesnt need due to other cov10.9 - Didnt understand application info7.6 - Automatically enrolled by state5.6 - Not worth the trouble1.9 - Other1.7 Those with TA more satisfied and saved more than expected

23. 23 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

24. 24 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