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PRESCRIPTION DRUG INITIATIVE - Senior Care

Background
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 from out of their own pockets. Adding to this burden, the number of prescriptions and costs per prescription has 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 the state's vulnerable seniors who lacked prescription drug coverage until the day when Medicare Part D drug benefit would be implemented. Funded at $73 million over three years, Senior Care started providing benefits on November 1, 2003.

Program
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 povery level (FPL) and who lacked any private or public prescription drug coverage could receive benefits.

Senior Care was subsequently redesigned starting September 1, 2004 to wrap-around the Medicare discount card so that NC seniors could use one card to access 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 for unexpended 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 bacame the fastest growing and 4th largest Pharmacy Assistance Program in the United States.

Outcomes
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.

For assistance with enrolling in the Medicare Prescription Drug program, please contact your local outreach coordinator.