Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices.. Access to Needed Drugs

04/01/2000

Because out-of-pocket spending for prescription drugs can take up a significant share of spending, some people may not be able to buy all of the medications they need. Data from the 1997 National Health Interview Survey confirm that, both among Medicare beneficiaries and in the total population, people without coverage are going without medications because they cannot afford them.27

Table 2-27 shows, for the total (Medicare and non-Medicare) population, NHIS estimates of people who reported that they needed prescription drugs but did not get them because they could not afford to. These data do not necessarily reflect cases in which people postponed filling a prescription, purchased less than the quantity prescribed, or took the medication less often than prescribed. About 3 percent of all people with health insurance, and 16 percent of people without health insurance, failed to get needed prescription medicine because they could not afford it. Note that health insurance in this table includes insurance that does not cover prescription drugs; thus all elderly people with Medicare fall into the insured column. If data were available on drug coverage, the differences would likely be even larger.

Table 2-27. Percent of Population Not Receiving Prescription Medicine Because of Cost, by Insurance Coverage and Selected Characteristics, 1997
  Percent reporting that they needed prescription medicine in the last 12 months but did not get it because they (or a parent) could not afford it
All persons With health insurance Without health insurance
       
Total 4.9% 3.0% 16.4%
       
Income (as % of Poverty)      
<Poverty 11.5% 7.6% 21.0%
100-150% 11.2% 8.0% 19.2%
150-200% 7.0% 4.8% 14.9%
200-300% 5.2% 3.4% 17.0%
300-400% 2.7% 1.9% 12.2%
>400% 1.4% 0.9% 13.7%
       
Health Status      
Excellent 2.1% 1.1% 8.9%
Very Good 3.7% 2.1% 13.7%
Good 6.9% 4.2% 19.6%
Fair 13.3% 9.2% 35.7%
Poor 21.9% 16.1% 60.5%
Source: Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control, National Health Interview Survey (NHIS), 1997.

People without insurance are consistently more likely than people with insurance to report that they couldn’t afford needed medicines. Among the uninsured, the problem is greatest for people with low incomes and for people in poor health. Over 60 percent of uninsured people in poor health reported not getting medicines they needed.

Table 2-28 and Figure 2-13 show the responses by more detailed insurance categories and income. Again, for both Medicare beneficiaries and the non-Medicare population, people without insurance and those with the lowest incomes were most likely to go without a prescription drug.28 About a sixth of low-income beneficiaries without supplemental coverage, and just over a fifth of low-income uninsured non-Medicare beneficiaries, reported not receiving a needed drug because of cost.

Figure 2-13. Medicare Beneficiaries Who Did Not Get a Needed Drug Because They Could Not Afford It, by Source of Insurance and Income, 1997

Figure 2-13. Medicare Beneficiaries Who Did Not Get a Needed Drug Because They Could Not Afford It, by Source of Insurance and Income, 1997

Note: Medicaid is not included at higher income level because sample size is too small to produce reliable estimates.

Source: Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control, National Health Interview Survey (NHIS), 1997.

Table 2-28. Percent of Population Not Receiving Prescription Medicine Because of Cost, by Detailed Insurance Status, 1997
Health Insurance Percent reporting that they needed prescription medicine in the last 12 months but did not get it because they (or a parent) could not afford it
Total 0-150% of poverty 150-300% of poverty 300% of poverty or more
Medicare beneficiaries        
Medicare FFS only 9.9% 16.9% 7.6% *
Medicare + non-Medicaid supplement 2.2% 7.8% 2.4% 0.6%
Medicare + Medicaid 8.8% 8.6% * *
         
Non-Medicare population        
Medicaid 6.2% 6.6% 7.6% *
Private 2.4% 7.1% 3.8% 1.2%
No Insurance 16.4% 20.3% 16.0% 13.0%

* Small cell size; estimates not reliable

Source: Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control, National Health Interview Survey (NHIS), 1997.

Medicare beneficiaries with no supplemental coverage were over four times as likely as those with a non-Medicaid supplement to report not receiving a drug they needed. Among the non-Medicare population, people without any insurance were almost eight times as likely as people with private insurance to report going without a needed drug.

Again, this difference between people with and without coverage would likely be even stronger if information were available on which supplements included drug coverage. As Chapter 1 showed, while many Medicare beneficiaries with supplemental coverage have drug coverage, most beneficiaries with an individually purchased policy do not have coverage for their drugs. This distinction may be less important for non-Medicare beneficiaries, who usually have drug coverage if they have health insurance.

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