The Demise of Oregon's Medically
Needy Program:
Effects of Losing Prescription Drug
Coverage and Pharmaceutical
Company Drug Assistance Programs
Judy Zerzan, MD, MPH
Oregon Health & Science University
Funded by a RWJ State Coverage Initiatives Grant
Office 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
50%
45%
36%
40%
34%
32%
35%
30%
30%
24%
25%
21%
20%
12%
15%
10%
5%
5%
4%
2%
0%
Excellent
Very Good
Medically Needy
Good
Fair
Poor
All Oregonians (BRFSS 2002, 18+)
Chronic Medical Problems
Average 3.5 Chronic Medical Conditions
(Range 0-25)
Disease
% Reporting
Hypertension
59%
Asthma
Diabetes
31%
Arthritis
20%
Depression
Back or neck conditions
19%
Heart attack
15%
High cholesterol
12%
Bipolar mood disorder
9%
Schizophrenia
8%
28%
17%
Most Commonly Used Drug Classes
Average 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
Family/Friends
Other
3%
3%
Drug Discount
Card
3%
100% Medically
Needy Program
Drug Company
Assist Program
29%
Samples
8%
Out of Pocket
48%
Other Insurance
5%
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)
100%
90%
82%
88%
80%
70%
62%
64%
66%
$51 to $100
$101 to
$200
$201 to
$300
60%
50%
47%
40%
30%
20%
10%
0%
$1 to $50
$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
45%
39%
40%
35%
29%
30%
25%
20%
15%
12%
15%
10%
5%
5%
0%
Much Better
Somewhat
Better
Same
Somewhat
Worse
Much Worse
Healthcare Utilization
6 months before/after end of MN program
(self-report)
500
450
422
430
400
350
Total
Number
300
227
250
179
200
150
100
p=0.04
50
0
ER Visits
Hospitalizations
Before
After
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