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A vital component of health care
More than 131 million people — 66 percent of all adults in the United States — use prescription drugs. Utilization is especially loftier for older people and those with chronic weather condition. Prescription drugs are costly. Some $73 billion — nigh 16 pct of total health care expenditures — was spent on prescription drugs for adults in 1998.(1) Prescription drugs are a vital component of efforts to maintain or improve health. Advances in new products and engineering and increases in utilization — the number of people using prescribed medicines and the number of prescriptions per user — take contributed to increases in overall prescription drug spending.(2) The rising cost of prescription drugs affects everyone, but specially high prescription drug users, uninsured individuals, and wellness plans. Virtually half of the cost of prescription drugs is paid out-of-pocket. Concerns about cost atomic number 82 some consumers to accept less than the prescribed medication.
People with chronic conditions depend on prescription drugs
The great majority of adults who take i of 5 common chronic conditions — diabetes, heart illness, hypertension, arthritis, and cancer — use prescription drugs. For example, 89 percentage of people with arthritis and 98 percent of people with diabetes use prescription drugs. People with these conditions fill many prescriptions annually and have meaning prescription drug expenditures. Adults with diabetes fill about four times as many prescriptions and spend about 4 times as much on prescription drugs as the general population. High prescription drug use may also reverberate the fact that people take multiple chronic conditions.
Who uses prescription drugs?
The proportion of people using prescription drugs and the amount of prescriptions filled varies by demographic group. Prescription drug use is associated with historic period, gender, race and ethnicity, income, and health status. For case, prescription drug use increases with historic period. Iii-quarters of those historic period l to 64 use prescription drugs, compared to 91 percent of those age 80 and older. The average number of prescriptions filled also increases with age, from 13 for those age l to 64 to 22 for those age 80 and older (run into Figure i).
The gender gap in prescription drug utilise narrows with historic period
Women are generally more likely than men to use prescription drugs. The gap in prescription drug use between men and women is striking for younger populations. Some twoscore percent of men and 66 per centum of women age 18 to 34 apply prescription drugs. Apply patterns converge as people get older, nonetheless. Like proportions of men and women age 65 and older are prescription drug users. For example, some 92 percent of men and 90 percentage of women age 80 and older use prescription drugs (see Figure 2).
Spending for prescription drugs increases with age
Prescription drug expenditures are highest for people historic period 65 and older. Drug expen-ditures are specially high for the oldest adults. For instance, average annual prescription drug expenditures for people age 80 and older are well-nigh ane.five times higher than those for people age 50 to 64 (run across Effigy three).
Older consumers pay for more than half of prescription drug expenditures out-of-pocket
Annual boilerplate out-of-pocket prescription drug expenditures for all adults are $177, merely people age 65 and older pay much more for their medications. People age 65 to 79 pay $456 out-of-pocket. People age 80 and older pay even more (see Effigy 4).
Adults pay almost one-half — 48 percent — of their expenses for prescription drugs out-of-pocket, but persons historic period 65 to 79 pay 56 percent and those age 80 and older pay 67 percent of their full drug expenditures out-of-pocket.
Out-of-pocket costs are particularly loftier for people with chronic weather
Consumers who have mutual chronic conditions have substantial prescription drug expenses. Since their total prescription drug expenditures are very high, their total out-of-pocket expenditures are also high. They pay most half of the cost of prescription drugs out-of-pocket. For example, adults with diabetes pay almost $700 out-of-pocket each year (encounter Figure 5).
Price affects compliance
Some people take less medication than prescribed considering of the cost. This is a particular problem for more vulnerable populations. For case, among adults who report poor wellness, about one-fourth -25 percent – of people age 51 to 64 and more than than one-tenth – 12 percent – of people age 65 and older say that they have taken less medication than prescribed in the past two years because of the cost. Substantial proportions of people with common chronic conditions also report that because of toll they have less than the prescribed amount of medication (see Figure six). The do of taking less medication than prescribed may increase overall health intendance costs if the result is more than emergency room visits, hospital admissions, or dr. visits.
A study of people age 65 and older in viii states reports that a substantial proportion of people, in particular those with low incomes, take less medicine than prescribed. For example, 22 percent of respondents signal that they had not filled prescriptions one or more times in the past year because of the cost. Some 23 percent say they skipped doses of medication to make it last longer. A substantial proportion of respondents — 21 percent — report that they spent less in the by year on food, heat, or other necessities then they could afford to purchase their medications.(3)
Medicaid beneficiaries pay the smallest proportion of prescription drug costs out-of-pocket
The Medicaid programme plays an important role in providing prescription drugs for a particularly vulnerable population. All Medicaid beneficiaries have very low incomes and almost one-3rd written report fair or poor health status. Nationally, Medicaid covers 60 percent of prescription drug expenditures, but beneficiaries still must pay nigh one-third of the price out-of-pocket. Because the program is state administered, the extent of Medicaid prescription drug coverage varies considerably amongst states, all the same. Medicare beneficiaries pay a much higher proportion of drug expenditures — 62 percentage — out-of-pocket (come across Effigy 7).
The boilerplate annual out-of-pocket prescription drug expenditure for Medicare beneficiaries is $581, compared to $297 for those on Medicaid and $156 for those with private insurance. For both the uninsured population and Medicare beneficiaries without prescription drug coverage, out-of-pocket drug expenditures may be loftier if they must pay the full retail price at the chemist's shop.
Fiscal Pressures Have Led States to Curb Medicaid Spending on Prescription Drugs
The Medicaid program is a significant part of state budgets. Over the past several years, Medicaid spending has grown. Spending on prescription drugs is 1 factor that has contributed to growth in Medicaid spending. Medicaid spending on prescription drugs grew, on average, past 18 percentage betwixt 1997 and 2000.4 In 2000, the program spent $21 billion on prescription drugs.
Equally states struggle to balance budgets, many have adopted policies to command Medicaid spending for prescription drugs. More than half of states report changes in Medicaid prescription drug policies for fiscal year 2003. Many states are negotiating for larger discounts and rebates on their prescription purchases. Another pop strategy is to place some limits on the types of drugs that can be prescribed past requiring prior authorization for prescriptions, using a preferred drug list, or requiring that generic drugs be prescribed. Some policy changes may have a more than firsthand effect on beneficiaries. These include plans to crave new or college copayments from beneficiaries and rules that limit the number of prescriptions per calendar month that Medicaid beneficiaries may make full.
Medicaid Pharmacy Policy Changes for Fiscal Year 2003
PolicyNumber of States Negotiating discounts 26
Prior authorization for more than prescriptions 22
Use of a preferred drug list 22
New or higher copayments 19
Seeking rebates 12
Requiring apply of generic drugs 9
Limits on number of prescriptions per calendar month half dozen
SOURCE: Wachino, V. (2002). Country budgets under stress: How are states planning to reduce the growth in Medicaid costs? Preliminary results based on the Kaiser Committee on Medicaid and the Uninsured 50-State Upkeep Survey. Washington, DC: The Kaiser Committee on Medicaid and the Uninsured. Available at http://www.kff.org.
Some people use herbal remedies
More than than 3 million people report using herbal remedies. The great bulk of herbal remedy users are women. Herbal drug users tend to be white and to be improve educated than the general population. They also are in somewhat better health than the general population (come across Effigy 8).
1. In the 1998 Medical Expenditure Console Survey, full health care expenditures are defined as inpatient hospital and dr. services, ambulatory physician and nonphysician services, prescribed medicines, home health services, dental services, and various other medical equipment and services that were purchased or rented during the yr.
2. Bruen, B.Chiliad. (2002). States strive to limit Medicaid expenditures for prescribed drugs. Washington, DC: The Kaiser Committee on Medicaid and the Uninsured. Available at http://www.kff.org.
3. Safran, D.G., P. Neuman, C. Schoen, J.Due east. Montgomery, West Li, I.B. Wilson, Chiliad.S. Kitchman, A.E. Bowen, and W.H. Rogers. (2002). "Prescription drug coverage and seniors: How well are states closing the gap?" Health Affairs – Web Exclusive: W253-W268. Available at http://www.healthaffairs.org.
4. Schneider, A. and L. Elam. (2002). Medicaid: Purchasing prescription drugs. Washington, DC: The Kaiser Commission on Medicaid and the Uninsured. Available at http://www.kff.org.
Well-nigh THE DATA
Unless otherwise noted, the information presented in this Profile are from two national surveys of the United states of america noncombatant non-institutionalized pop-ulation. The 1998 Medical Expenditure Console Survey (MEPS), cosponsored by the Agency for Healthcare Inquiry and Quality and the National Center for Health Statistics, provides national estimates of wellness care utilize, expenditures, sources of payment, and insurance coverage. The 1998 Health and Retirement Study (HRS) provides information near the population age 51 and older. HRS is sponsored by the National Institute on Crumbling and conducted past the Institute for Social Research at the Academy of Michigan.
ABOUT THE PROFILES
This is the second set of Data Profiles in the series, Challenges for the 21st Century: Chronic and Disabling Conditions. The serial is supported past a grant from the Robert Wood Johnson Foundation. This Profile was written past Emily Ihara with assistance from Laura Summer and Lee Shirey. Information technology is the 5th in the serial. Previous Profiles include:
one. Screening for Chronic Conditions: Underused services
2. Babyhood Obesity: A lifelong threat to health
three. Visual Impairment: A growing concern as the population ages
four. Cancer: A major national concern
The Eye on an Aging Club is a Washington-based nonpartisan policy group located at Georgetown University's Institute for Health Care Research and Policy. The Center studies the impact of demographic changes on public and private institutions and on the economic and wellness security of families and people of all ages.
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