Geography still dictates Rx coverage for many near-poor seniors and disabled persons

State-to-state differences in generosity of assistance programs targeted toward poor seniors and people with disabilities have always been the "price of federalism." Typically, these differences are vitiated when federal law enters a field. Not so with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. States' choices of how much of the uncovered burden of prescription drug costs is left to near-poor elderly and disabled residents continues to vary widely even though Medicare began to provide pharmaceutical coverage beginning January 2006. The purpose of this article is to address the role that state policies play in promoting continued variation in access to prescription drugs.