Medicare beneficiaries' management of capped prescription benefits

BACKGROUND. Having annual dollar limits in prescription coverage is a type of benefit design unique to Medicare beneficiaries. This type of coverage i s found predominantly within private Medigap policies and Medicare+Choice p lans offering prescription coverage. OBJECTIVES. The purpose of this study was to determine the impact of capped prescription benefits on efforts to reduce out-of-pocket prescription expe nses by beneficiaries at risk for reaching their cap. RESEARCH DESIGN. This design was quasiexperimental, with data obtained from self-administered questionnaires mailed to 600 Medicare HMO risk enrollees with capped prescription benefits. RESULTS. Data were collected on 378 Medicare enrollees for a 63% response r ate. Approximately half of all respondents participated in greater than or equal to1 strategy to reduce their out-of-pocket prescription expenses. Par ticipation in selected strategies included obtaining samples from physician s (39.2%), taking less than prescribed amounts (23.6%), and discontinuing p rescribed medications (16.3%). Additionally, 15% of respondents indicated g oing without necessities, and 12% indicated borrowing money to pay for thei r prescriptions. Those who reached their prescription cap were more likely to participant in any one behavior (odds ratio [OR], 2.18), more likely to take less medication than prescribed (OR, 2.83), more likely to discontinue a medication (OR, 3.36), and more likely to obtain samples from their phys ician (OR, 2.02) compared with those who had not reached their prescription cap. CONCLUSIONS. Beneficiaries at risk for reaching their prescription cap are taking steps to reduce their out-of-pocket prescription costs. Although som e behaviors would be considered prudent other behaviors may be placing bene ficiaries at risk for drug-related morbidity and mortality.