The Problem
The average senior citizen spends more than $1,700 per year on
prescription drugs. And despite this group's typical dependence on
limited and/or fixed incomes, a great deal of that medication is paid
for out of their own pockets. Adding to this burden, the cost and
number of prescriptions have increased dramatically in recent years,
forcing many seniors to choose between food and housing or taking the
medicines they need. In light of the federal government's failure to
provide seniors with prescription drug coverage under Medicare, more
than half of the states developed their own programs to respond to this
critical issue.
Objective
Recognizing the acute need for prescription assistance by North
Carolina senior citizens, HWTF created Senior Care as a bridge to help
vulnerable seniors prior to the implementation of Medicare Part D drug
benefits. Funded by $73 million over three years, Senior Care started
providing benefits on November 1, 2003.
HWTF Solution (program description)
As originally designed, Senior Care offered a traditional drug
benefit under which the state covered 60% of the first $1,000 ($600
maximum) for the cost of prescription drugs and insulin relating to the
treatment of cardiovascular disease, chronic obstructive pulmonary
disease and/or diabetes. These three diseases were initially targeted
due to their high prevalence in seniors, as it is estimated that at
least one of them effects 75% of the elderly in North Carolina. Seniors
whose income was less than 200% of the Federal Poverty Level (FPL), and
who lacked any private or public prescription drug coverage, could
receive benefits.
Starting on September 1, 2004, Senior Care was subsequently
redesigned to include the Medicare discount card, allowing seniors to
use one card that accessed both state and federal benefits. Since then,
Senior Care has:
- Covered prescriptions for all diagnostic states
- Covered seniors below 250% of FPL without any drug coverage
- Provided a benefit of up to $1,200 annually and covered all prescription drugs
- Allowed unused benefits from the previous year to be carried forward
- Paid a previously uncovered fee for dispensing and claims administration
- Covered
North Carolina seniors who are below 100% of FPL and pays 5% of the
cost of drugs, while seniors who are above that income level pay 10%
- Collaborated with Community Care Rx to attract more than $41 million in total Medicare dollars
- Filled more than 2.5 million prescriptions for NC seniors
- Provided
low-cost medicine to more than 115,000 North Carolina citizens who need
it most; average assistance per member was $790
As a result of these improvements, Senior Care became the fastest
growing and fourth-largest Pharmacy Assistance Program in the United
States.
Key Accomplishments (outcomes to date)
As part of its overall outcomes analysis of the Senior Care program,
the UNC School of Public Health conducted an evaluation of over 300
Senior Care participants. Survey results over the first two years of
the program revealed:
- Senior Care enrollees who reported not filling a prescription decreased from 23% to 14%
- The percentage of enrollees taking medications less often than prescribed decreased from 27% to 17%
- The amount enrollees spent on prescription drugs over four months decreased from $167 to $128
- The proportion of enrollees reporting overnight hospitalization decreased from 22% to 8%
- The proportion of enrollees reporting an emergency room visit decreased from 18% to 9%
North Carolina A&T University performed a concurrent evaluation
of the program's impact amongst minority populations and found similar
positive outcomes. North Carolina was recognized as a leader by the
U.S. Administration of Aging for its success in enrolling seniors in a
state-funded prescription drug benefit program. Senior Care has been
phased out since January 1, 2006 upon the introduction of Medicare Part
D.