The Demise of Oregon's Medically Needy Program:

Effects of Losing Prescription Drug Coverage and Pharmaceutical

Company Drug Assistance Programs

Judy Zerzan, MD, MPHOregon Health & Science University

Funded by a RWJ State Coverage Initiatives GrantOffice of Oregon Health Policy and Research

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

Oregon’s 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

Objectives

• Conducted 6 months after program end

• Describe population and use of prescription drugs

• Investigate changes

– Health status

– Financial impact

– ER visits and hospitalizations

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

Characteristics of Participants• 64% women

• Average age 58 years (range 22-91)

• Predominantly white (92%)

• 95% unemployed

• 85% gross income levels <$15,000 per year (2002)

Health Insurance

• 92% covered by Medicare

• 21% covered by other health insurance

• 4.6% had prescription drug benefits

Current Overall Health

2%

5%

24%

36%

32%30%

4%

12%

34%

21%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Excellent Very Good Good Fair Poor

Medically Needy All Oregonians (BRFSS 2002, 18+)

Chronic Medical ProblemsAverage 3.5 Chronic Medical Conditions

(Range 0-25)

Disease % Reporting

Hypertension 59%

Asthma 31%

Diabetes 28%

Arthritis 20%

Depression 19%

Back or neck conditions 17%

Heart attack 15%

High cholesterol 12%

Bipolar mood disorder 9%

Schizophrenia 8%

Most Commonly Used Drug ClassesAverage 5.5 prescriptions per month

(Range 0-27)

Drug Classes % Reporting

Antidepressants 53%

Narcotics 26%

Anti-psychotics 26%

Oral hypoglycemics 25%

Anxiolytics 25%

Statins 25%

ACE inhibitors 24%

Beta-blockers 21%

Diuretics 20%

Thyroid 19%

Primary Method of Payment for Prescriptions

Before After

100% Medically Needy Program

Drug Discount Card3%

Family/Friends3%

Samples8% Other Insurance

5%

Other3%

Out of Pocket48%

Drug Company Assist Program 29%

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

Percentage Not Filling a Prescription by Monthly Out-of-Pocket Prescription Expenses

(6 months)

66%

82%88%

62% 64%

47%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$1 to $50 $51 to $100 $101 to$200

$201 to$300

$301 to$400

Over $400

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

Health Status Compared to One Year Ago

5%

12%

39%

29%

15%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Much Better SomewhatBetter

Same SomewhatWorse

Much Worse

Healthcare Utilization6 months before/after end of MN program

(self-report)

422

227

430

179

0

50

100

150

200

250

300

350

400

450

500

ER Visits Hospitalizations

Before

After

Total Number

p=0.04

Drug Company Patient Assistance Programs

• 45% currently use

• 68% get assistance filling out paperwork

– primarily from a doctor’s office or clinic

• 55% report using these programs is very

or somewhat hard to do

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

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% didn’t finish the paperwork

• 1/3 who have not applied give the following reasons:

– don’t know much about

– can afford some prescriptions

– too much hassle

– need assistance with the paperwork

– aren’t available of the drugs they need

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

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

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

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

Thanks to:

Tina Edlund, Lisa Krois and Jeanene Smith from Office for Oregon Health Policy and Research

Dan Touchette and Dean Haxby from OHSU