Judy Zerzan, MD, MPH Oregon Health & Science University

1. 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

2. 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

3. 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

4. Objectives • Conducted 6 months after program end • Describe population and use of prescription drugs • Investigate changes • Health status • Financial impact • ER visits and hospitalizations

5. 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

6. 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)

7. Health Insurance • 92% covered by Medicare • 21% covered by other health insurance • 4.6% had prescription drug benefits

8. Current Overall Health

9. Chronic Medical Problems Average 3.5Chronic Medical Conditions (Range 0-25)

10. Most Commonly Used Drug Classes Average5.5prescriptions per month (Range 0-27)

11. Primary Method of Payment for Prescriptions Before After 100% Medically Needy Program Drug Company Assist Program 29%

12. 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

13. Percentage Not Filling a Prescription by Monthly Out-of-Pocket Prescription Expenses(6 months)

14. 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

15. Health Status Compared to One Year Ago

16. Healthcare Utilization6 months before/after end of MN program(self-report) Total Number p=0.04

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Thanks to: Tina Edlund, Lisa Krois and Jeanene Smith from Office for Oregon Health Policy and Research Dan Touchette and Dean Haxby from OHSU