New Kaiser study finds elderly confused by Medicare law, but association for pharmacy benefit managers disputes the findings
Fostering the kind of one-on-one decision-making help that physicians, pharmacists, and others can give seniors may be the most important thing that can be done to help the new Medicare prescription drug law succeed, said researchers who polled Medicare beneficiaries recently.
The new data found seniors are mostly negative and very confused about the law, which indicates that implementing it will be "a very rocky road unless more is done to educate the public about it," said Drew Altman, Ph.D., president of the Kaiser Family Foundation. The foundation, in cooperation with Harvard School of Public Health, asked 1,223 Medicare beneficiaries a variety of questions about the law. The poll results were released recently at a press briefing in Washington, D.C.
The survey found that 47% of Medicare beneficiaries have an unfavorable impression of the new law and another 25% said they did not know enough to offer an opinion. Of that 47% with an unfavorable impression, almost 75% said a major reason was that it was too complicated. That feeling of confusion came in second only to the idea that the law does not provide enough help on drug costs, a reason cited by 81% of people with an unfavorable impression.
Most beneficiaries (62%) said they had not heard enough to decide if they would enroll when the benefit becomes available in 2006. Ironically, that level was even higher among those without Rx coverage, at 65%.
Regarding the currently available Medicare discount cards, 53% said they aren't worth the trouble because they don't do enough or they are too confusing. "Clearly all the data suggest there is a lot of work to do to help people understand this law," said Mollyann Brodie, Ph.D., the Kaiser foundation's VP and director of public opinion and media research.
Responding to the poll, Peter Ashkenaz, spokesman for the Centers for Medicare & Medicaid Services, said that in terms of the Part D benefit, "The good thing is we're a year and a half away. We are going to be using aggressive work to educate Medicare beneficiaries."
Gail Wilensky, Ph.D., a senior fellow at Project Hope and a former head of the Health Care Financing Administration, said, "I am not surprised that there is a lot of negative feeling. Politicians, particularly Democrats, have been trashing the bill since it was passed. That's unfortunate."
The Pharmaceutical Care Management Association, the trade group for pharmacy benefit managers, issued a statement saying the report "plays into the hands of those seeking to undermine" the benefit. The potential savings for Medicare enrollees are real, said PCMA, citing a PricewaterhouseCoopers analysis it sponsored that found "market-based pharmacy benefit management will save Medicare beneficiaries in private plans $693 billion over the next 10 years."
The Kaiser and Harvard researchers also indicated that education of beneficiaries would have to happen on a very individual basis. The new poll confirmed that the cohort currently over 65 is not likely to use the Internet to get information. Only 10% have ever called 1-(800) Medicare, and 38% had not even heard of that telephone number.
Because other data have indicated that seniors often want to follow others' recommendations and do what other people are doing, Brodie said, you cannot underestimate the role of physicians and pharmacists, as well as friends and family, in helping patients make decisions about using plans under the new law.
In other findings from the poll, the researchers also pointed out that despite the negative feelings about the law, there is little evidence of a backlash against it. Two-thirds of beneficiaries said lawmakers should work to fix the law, as opposed to repealing it or leaving it as it is.
On the drug importation issue, the poll indicated Medicare recipients just don't believe drug research and development would be hurt by allowing Americans to buy Rx drugs from Canadian pharmacies. When the poll asked whether importation from Canada would lead U.S. drug companies to do less R&D, 71% of people who responded disagreed. Two-thirds said that allowing such importation would "make medicines more affordable without sacrificing safety or quality." Similarly, 62% disagreed with the idea that importation would expose Americans to unsafe medicines.
Also, 80% of the respondents said they favor changing the law to allow the federal government to negotiate with drug firms for lower prices, and 61% disagreed with the idea that negotiation would lead to less R&D.
Kathryn Foxhall. New poll finds seniors confused about Medicare drug benefit.
Sep. 13, 2004;148:29.