State-Run Rx Programs for Low-Income Seniors in Illinois and Wisconsin Show how Differences in Coverage Affect Enrollment, Rx Use and Spending

Study of the role of benefit design in enrollment, drug use, and expenditures in two state prescription drug programs for seniors

In this 2004–06 project, Cindy Parks Thomas, PhD, and researchers at Brandeis University used data from two state-run prescription drug programs (Illinois and Wisconsin) for low-income seniors to examine how differences in prescription drug coverage affect enrollment, drug use and spending in state programs for low-income seniors and people who are disabled.

This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO). HCFO supports policy analysis, research, evaluation and demonstration projects that provide public and private decision leaders with usable and timely information on health care policy and financing issues.

Key Findings

  • The Findings Brief, "Design of a Pharmacy Benefit for Low-Income Seniors: Lessons from State Pharmacy Assistance Programs," reports the following key findings:

    • In each state, enrollees in the prescription drug programs for low-income seniors were older and had higher incomes, more diseases, higher frailty scores and higher Medicare Part A (hospital) expenses than did nonenrollees. They also were more likely than nonenrollees to be female and white and to live in nonurban areas.
    • The Wisconsin program, which had higher cost sharing and tighter controls over prior authorization, led to a 10 percent increase in the use of generic drugs, lower overall drug spending and fewer prescriptions at every income level than did the Illinois program.
    • The differences in spending and generic drug use are greatest at the lowest income levels.
    • In Illinois, a cap on benefits had a strong effect on how drugs were used.

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