Out-of-pocket expenses for prescriptions surprisingly high
At the Rockville, MD-based Agency for Healthcare Research and Quality's (AHRQ) 2008 annual conference, Jessica S. Banthin, PhD, director of AHRQ's division of modeling and simulation in the center for financing, access and cost trends, was one of the presenters of a paper on "Prescription Drug Expenditures and Healthcare Burdens in the Medicaid Population." Dr. Banthin says this research still is a work in progress.
"We have redone the analyses in order to focus particularly on a trend we've identified," says Dr. Banthin. This involves the Medical Expenditure Panel Survey data, which show high out-of-pocket expenditures for prescription drugs even among families where everyone is covered by Medicaid.
The researchers focused on data from 2004 and 2005 for a subset of families where every person is covered for the full year by Medicaid. This accounts for about one-quarter of the nonelderly Medicaid population. "We did this to make the analysis as precise as possible," says Dr. Banthin.
The researchers found that about 14% of this group has high out-of-pocket burdens for health care. This means they spend more than 5% of their family income on out-of-pocket costs for health care services, totaling about $900 per family per year.
"About two-thirds of families who meet our definition of 'high burden' are in this category because of prescription drug expenditures," says Dr. Banthin. "Since every member of the family has Medicaid, it is surprising that they are spending so much out of pocket on prescription drugs. Copays for Medicaid enrollees are supposed to be nominal, about $3 to $5 per prescription or refill."
Dr. Banthin says that the research team is continuing to explore these findings. Preliminary evidence suggests that some of the spending derives from copayments. However, a large portion also derives from prescriptions where the Medicaid enrollee has paid the full retail pharmacy price and has not bothered to use or apply his or her Medicaid benefits.
"We do not yet know whether this is because of Medicaid rules that require prior authorization, step therapy, or place limits on the number of fills per month," says Dr. Banthin.
Contact Dr. Banthin at (301) 427-1678 or [email protected].
At the Rockville, MD-based Agency for Healthcare Research and Quality's (AHRQ) 2008 annual conference, Jessica S. Banthin, PhD, director of AHRQ's division of modeling and simulation in the center for financing, access and cost trends, was one of the presenters of a paper on "Prescription Drug Expenditures and Healthcare Burdens in the Medicaid Population." Dr. Banthin says this research still is a work in progress.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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