Prescription use behavior among medicare beneficiaries with capped prescription benefits

To evaluate the strategies Medicare beneficiaries adopt to manage their out-of-pocket prescription costs in a prescription drug plan with maximum (.capped.) benefits and to evaluate differences in the likelihood of participating in any one strategy before and after exhaustion of capped prescription benefits.

Self-administered surveys were mailed to 786 Medicare+Choice members with capped annual prescription drug benefits of 500 dollars or 1,000 dollars.

Two hundred twenty-one surveys were returned, for a 28% response rate. More than 70% of respondents participated in at least one strategy to manage prescription costs. The most frequently reported strategies included obtaining samples from their physician (45%), reducing spending on food and/or clothing (37%), shopping around at other pharmacies to obtain medications at a lower cost (29%), taking less than the prescribed amount (24%), receiving financial assistance from family or friends (17%), and stopping one or more regular-use medications (15%). More than two thirds of those who participated in at least one strategy participated in 2 or more strategies. While the combinations of strategies suggested prudence on the part of respondents (e.g., obtaining samples, shopping around), a subset of respondents participated in strategies that would be considered less desirable (e.g., stopping medications and taking less than prescribed). Finally, more than 35% indicated that they did not know their cap amount, and 24% did not know whether they had exhausted their benefit in 2000.

These findings highlight the difficulties many Medicare beneficiaries face in managing prescription costs, even those with some coverage for prescription costs. In the design of prescription coverage for the elderly, policy makers should recognize the impact that capped benefits have on member behavior. The apparent high rate of reliance upon prescription drug samples to reduce prescription drug expenditures for many Medicare+Choice members raises the question of whether prescription drug samples may discourage the prescribing of lower-cost therapeutic alternatives.