The Demise of Oregon’s Medically Needy Program: Effects of Losing Prescription Drug Coverage
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In January 2003, people covered by Oregon’s Medically Needy program lost benefits owing to state budget shortfalls. The Medically Needy program is a federally matched optional Medicaid program. In Oregon, this program mainly provided prescription drug benefits.
To describe the Medically Needy population and determine how benefit loss affected this population’s health and prescription use.
A 49-question telephone survey instrument created by the research team and administered by a research contractor.
A random sample of 1,269 eligible enrollees in Oregon’s Medically Needy Program. Response rate was 35% with 439 individuals, ages 21–91 and 64% women, completing the survey.
Demographics, health information, and medicatication use at the time of the survey obtained from the interview. Medication use during the program obtained from administrative data.
In the 6 months after the Medically Needy program ended, 75% had skipped or stopped medications. Sixty percent of the respondents had cut back on their food budget, 47% had borrowed money, and 49% had skipped paying other bills to pay for medications. By self-report, there was no significant difference in emergency department visits, but a significant decrease in hospitalizations comparing 6 months before and after losing the program. Two-thirds of respondents rated their current health as poor or fair.
The Medically Needy program provided coverage for a low-income, chronically ill population. Since its termination, enrollees have decreased prescription drug use and increased financial burden. As states make program changes and Medicare Part D evolves, effects on vulnerable populations must be considered.
- Soumerai SB, Ross-Degnan D. Inadequate prescription-drug coverage for Medicare enrollees—a call to action. N Engl J Med. 1999;340:722–8. CrossRef
- Stuart B, Zacker C. Who bears the burden of Medicaid drug copayment policies? Health Aff (Project Hope). 1999;18:201–12. CrossRef
- Piette JD, Heisler M, Wagner TH. Problems paying out-of-pocket medication costs among older adults with diabetes. Diabetes Care. 2004;27:384–91. CrossRef
- Safran DG. Seniors and prescription drugs: findings from a 2001 survey of seniors in eight states. The Commonwealth Fund/Kaiser Family Foundation/Tufts-New England Medical Center; July 2002.
- Xu KT. Financial disparities in prescription drug use between elderly and nonelderly Americans. Health Aff (Project Hope). 2003;22:210–21. CrossRef
- Tseng CW, Brook RH, Keeler E, Steers WN, Waitzfelder BE, Mangione CM. Effect of generic-only drug benefits on seniors’ medication use and financial burden. Am J Manag Care. 2006;12:525–32.
- Lurie N, Ward NB, Shapiro MF, Brook RH. Termination from Medi-Cal—does it affect health? N Engl J Med. 1984;311:480–4. CrossRef
- Lurie N, Ward NB, Shapiro MF, Gallego C, Vaghaiwalla R, Brook RH. Termination of Medi-Cal benefits. A follow-up study one year later. N Engl J Med. 1986;314:1266–8. CrossRef
- Saver BG, Doescher MP, Jackson JE, Fishman P. Seniors with chronic health conditions and prescription drugs: benefits, wealth, and health. Value Health. 2004;7:133–43. CrossRef
- Kleinke JD. The price of progress: prescription drugs in the health care market. Health Aff (Project Hope). 2001;20:43–60. CrossRef
- Tseng CW, Brook RH, Keeler E, Mangione CM. Impact of an annual dollar limit or “cap” on prescription drug benefits for Medicare patients. JAMA. 2003;290:222–7. CrossRef
- Harris BL, Stergachis A, Ried LD. The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Med Care. 1990;28:907–17. CrossRef
- Johnson RE, Goodman MJ, Hornbrook MC, Eldredge MB. The effect of increased prescription drug cost-sharing on medical care utilization and expenses of elderly health maintenance organization members. Med Care. 1997;35:1119–31. CrossRef
- Crowley JS, Ashner D, Elam L. Medicaid outpatient prescription drug benefits: findings from a national survey. 2003. Available at: http://www.kff.org/medicaid/4164.cfm. Accessed October 18, 2006.
- Oregon Department of Human Services Memo. Oregon Department of Human Services, State of Oregon; June 2003.
- CMS. Prescription drug coverage: General information 2006. Centers for Medicaid and Medicare Services. Available at: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/. Accessed October 18, 2006.
- Brodie M, Blendon R. National survey on prescription drugs. Health Desk: A Partnership of the Kaiser Family Foundation and the Newshour with Jim Lehrer; 2000.
- Berk ML, Schur CL, Mohr P. Using survey data to estimate prescription drug costs. Health Aff (Project Hope). 1990;9:146–56. CrossRef
- Barnes PM, Adams PF, Schiller JS. Summary of health statistics for the US population: National Health Interview Survey, 2001. National Center for Health Statistics. Vital Health Stat. 2003;27.
- CDC Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion. 2004. Available at: http://www.cdc.gov/brfss/. Accessed October 18, 2006.
- MedPAC. Dual eligible beneficiaries: an overview. Report to the Congress: New approaches in Medicare, section 3. 2004:71–91.Available at: http://www.medpac.gov/publications/congressional_reports/Jun06DataBookSec3.pdf. Accessed October 18, 2006.
- Cunningham PJ. Medicaid cost containment and access to prescription drugs. Health Aff (Project Hope). 2005;24:780–9. CrossRef
- Piette JD, Heisler M. Problems due to medication costs among VA and non-VA patients with chronic illnesses. Am J Manag Care. 2004;10:861–8.
- Piette JD, Heisler M, Wagner TH. Cost-related medication underuse among chronically ill adults: the treatments people forgo, how often, and who is at risk. Am J Pub Health. 2004;94:1782–7. CrossRef
- Tseng CW, Brook RH, Keeler E, Steers WN, Mangione CM. Cost-lowering strategies used by Medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage. JAMA. 2004;292:952–60. CrossRef
- Soumerai SB, Avorn J, Ross-Degnan D, Gortmaker S. Payment restrictions for prescription drugs under Medicaid: effects on therapy, cost, and equity. N Engl J Med. 1987;317:550–6. CrossRef
- Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin T, Choodnovskiy I. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. N Engl J Med. 1991;325:1072–7. CrossRef
- Motheral B, Fairman KA. Effect of a three-tier prescription copay on pharmaceutical and other medical utilization. Med Care. 2001;39:1293–304. CrossRef
- Tamblyn R, Laprise R, Hanley JA, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285:421–9. CrossRef
- Rector TS, Venus PJ. Do drug benefits help Medicare beneficiaries afford prescribed drugs? Health Aff (Project Hope). 2004;23:213. CrossRef
- Mojtabai R, Olfson M. Medication costs, adherence, and health outcomes among Medicare beneficiaries. Health Aff (Project Hope). 2003;22:220–9. CrossRef
- Caskie GI, Willis SL. Congruence of self-reported medications with pharmacy prescription records in low-income older adults. Gerontologist. 2004;44:176–85.
- Boudreau DM, Daling JR, Malone KE, Gardner JS, Blough DK, Heckbert SR. A validation study of patient interview data and pharmacy records for antihypertensive, statin, and antidepressant medication use among older women. Am J Epidemiol. 2004;159:308–17. CrossRef
- Boudreau DM, Doescher MP, Saver BG, Jackson JE, Fishman PA. Reliability of Group Health Cooperative automated pharmacy data by drug benefit status. Pharmacoepidemiol Drug Saf. 2005;14:877–84. CrossRef
- Iglehart JK. The dilemma of Medicaid. N Engl J Med. 2003;348:2140–8. CrossRef
- Baugh DK, Pine PL, Blackwell S, Ciborowski G. Medicaid prescription drug spending in the 1990s: a decade of change. Health Care Financ Rev. 2004;25:5–23.
- The Demise of Oregon’s Medically Needy Program: Effects of Losing Prescription Drug Coverage
Journal of General Internal Medicine
Volume 22, Issue 6 , pp 847-851
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- prescription drugs
- vulnerable populations
- survey research
- Industry Sectors
- Author Affiliations
- 1. Seattle VA Health Services Research and Development, 1100 Olive Way, #1400, Seattle, WA, 98101, USA
- 2. University of Washington, Seattle, WA, USA
- 3. Oregon Health Sciences University, Portland, OR, USA
- 4. Office for Oregon Health Policy and Research, State of Oregon, Salem, OR, USA