Chartpack Medicare Prescription Drug Benefit Progress Report: Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey.

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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.

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Chartpack 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 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. This chartpack is based on an article (published online 21 August 2007) in Health Affairs, “Medicare Prescription Drug Benefit Progress Report: Findings from a 2006 National Survey of Seniors” available at The charts were prepared by Tricia Neuman, Michelle Kitchman Strollo, and Kim Boortz of the Kaiser Family Foundation; Stuart Guterman and Sophie Kasimow of the Commonwealth Fund; Angela Li of the Tufts-New England Medical Center; and Dana Gelb Safran of Blue Cross Blue Shield of Massachusetts. Methodology

Prescription Drug Coverage of Non-Institutionalized Seniors

Share of Seniors Who Said They Were Without Drug Coverage in 2005 and 2006 SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, Chart 1 NOTES: Sample excludes institutionalized seniors. Numbers are rounded.

Distribution of Seniors’ Drug Coverage in 2006 Among Those Who Did Not Have Drug Coverage in 2005 Yes No Drug coverage in 2005: SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, Source of Drug Coverage in 2006: No Rx Coverage Other Part D VA Employer NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. Chart 2

Part D Employer VA Other Coverage None Distribution of Seniors by Primary Source of Drug Coverage, 2006 NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, Chart 3

Part D Coverage Rates Among Seniors with Selected Characteristics, 2006 NOTES: Sample excludes institutionalized seniors. 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 White African American Non-White Hispanic ≤ 100% % % >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, Chart 4

Lack of Any Drug Coverage Among Seniors with Selected Characteristics, 2006 Total White African American Non-White Hispanic ≤ 100% % % >200% 1 or 2 3 or more None Race/Ethnicity % Poverty Chronic Conditions Rural Urban Urban/Rural Location * * * * * * NOTES: Sample excludes institutionalized seniors. 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, Chart 5

Seniors’ Drug Coverage in Selected States, 2006 SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, NOTES: Sample excludes institutionalized seniors. 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 NOTES: Sample excludes institutionalized seniors. 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 (<$14,700/individual and <$19,800/couple). 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, Chart 7

Characteristics of Non- Institutionalized Seniors with Various Sources of Drug Coverage

Income Distribution of Seniors, by Source of Drug Coverage, 2006 NOTES: Sample excludes institutionalized seniors. 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, Chart 8

Race/Ethnicity of Seniors, by Source of Drug Coverage, 2006 NOTES: Sample excludes institutionalized seniors. 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, Chart 9

Rural/Urban Residence of Seniors, by Source of Drug Coverage, 2006 NOTES: Sample excludes institutionalized seniors. 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, Chart 10

Number of Prescriptions Taken by Seniors, by Source of Drug Coverage, 2006 NOTES: Sample excludes institutionalized seniors. 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, Chart 11

Prescription Drug Use, Out-of-Pocket Spending, and Non-Adherence

Mean Number of Prescriptions Filled by Seniors, by Source of Drug Coverage, 2006 NOTES: Sample excludes institutionalized seniors. 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, (Among Seniors Taking 1 or More Rx) Chart 12

Share of Seniors Spending More Than $300 on Prescriptions in the Last 30 Days, by Source of Drug Coverage, 2006 NOTES: Sample excludes institutionalized seniors. 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, (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: Sample excludes institutionalized seniors. “Did not fill/delayed filling” refers to not filling or delayed 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, (Among Seniors Taking 1 or More Rx) Chart 14

Notes: Sample excludes institutionalized seniors. 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. SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Dugs, Chart 15 Source of Coverage vs. Reference Group None vs. Part D Part D vs. Employer Part D vs. VA Spent >$100 in the Last 30 Days Spent >$300 in the Last 30 Days Did Not Fill/Delayed Fill or Refill Due to Cost in the Past 12 Months Multivariate Results Showing Association Between Sources of Drug Coverage, Out-of-Pocket Spending, and Non-Adherence, 2006 (Odds Ratios)

Share of Seniors Who Purchased Prescriptions From Canada or Mexico, by Source of Drug Coverage, 2006 SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, NOTES: Sample excludes institutionalized seniors. 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 Seniors, by Plan Type, 2006 Medicare Advantage Prescription Drug Plan (MAPD) Stand-Alone Prescription Drug Plan (PDP) SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, Chart 17 NOTES: Sample excludes institutionalized seniors. Numbers are rounded.

Share of Seniors in Part D Plans (PDP vs. MAPD) with Selected Characteristics, 2006 NOTES: Sample excludes institutionalized seniors. 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, (per month) Chart 18

Race/Ethnicity of Seniors in Part D Plans, by Part D Plan Type, 2006 NOTES: Sample excludes institutionalized seniors. 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, Chart 19

Prescription Out-of-Pocket Spending and Non-Adherence Among Seniors in Part D Plans, by Part D Plan Type, 2006 NOTES: Sample excludes institutionalized seniors. “Did not fill/delayed filling” refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. 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, (Among Seniors Taking 1 or More Rx) Chart 20

The Part D Low-Income Subsidy (LIS)

Drug Coverage Among Seniors with Incomes At or Below 150% of Poverty Who Were Not Receiving the Low- Income Subsidy (LIS), 2006 Part D Employer/ VA Other No Rx Coverage SOURCE: Kaiser/Commonwealth/Tufts-New England Medical Center National Survey of Seniors and Prescription Drugs, NOTES: Sample excludes institutionalized seniors. VA is Department of Veterans Affairs. Numbers are rounded. Chart 21 Nearly half of all seniors at or below 150% of poverty without the low-income subsidy are in a Part D plan

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 Without LISWith LIS (excluding Dual Eligibles) NOTES: Sample excludes institutionalized seniors. “Did not fill/delayed filling” refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. Weighted percentages. Excludes 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, (Among Seniors Taking 1 or More Rx) Chart 22

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, % - 150% 101% - 134% ≤100% Non-White Hispanic African American White % Poverty Race/Ethnicity NOTES: Sample excludes institutionalized seniors. Weighted percentages. Reference Groups: % 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, Chart 23

Seniors in Part D Plans Who Spent More Than $100 on Prescriptions in the Last 30 Days, by Income Level and Low-Income Subsidy (LIS) Status, 2006 NOTES: Sample excludes institutionalized seniors. 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, (Among Seniors Taking 1 or More Rx) Chart 24

Seniors in Part D Plans Who Spent More Than $300 on Prescriptions in the Last 30 Days, by Income Level and Low-Income Subsidy (LIS) Status, 2006 NOTES: Sample excludes institutionalized seniors. 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, (Among Seniors Taking 1 or More Rx) Chart 25

Seniors in Part D Plans Who Did Not Fill or Delayed Filling a Prescription Due to Costs, by Income Level and Low-Income Subsidy (LIS) Status, 2006 NOTE: Sample excludes institutionalized seniors. “Did not fill/delayed filling” refers to not filling or delayed filling or refilling a prescription because of cost in the past twelve months. 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, (Among Seniors Taking 1 or More Rx) Chart 26

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, NOTE: Sample excludes institutionalized seniors. 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 27

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, NOTE: Sample excludes institutionalized seniors. 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 28