Promoting Access and Reducing Expected Out-of-Pocket Prescription Drug Costs for Vulnerable Medicare Beneficiaries

BACKGROUND: The Medicare Part D benefit is complicated and may be costly, especially for vulnerable low-income populations where lack of resources and limited English proficiency may be barriers to optimal plan selection. OBJECTIVES: To identify vulnerable Medicare beneficiaries and lower their expected annual out-of-pocket (OOP) prescription drug costs through one-on-one prescription drug plan counseling by pharmacists and trained pharmacy students. RESEARCH DESIGN: Between October 2008 and January 2010, a cross-sectional study was performed throughout California. Using Medicare's Prescription Drug Plan Finder tool, expected annual OOP costs for each beneficiary's current prescription drug plan were compared with the lowest-cost plan. SUBJECTS: The study sample included vulnerable Medicare beneficiaries with annual incomes ≤300% of the Federal Poverty Level. RESULTS: There were 1300 vulnerable beneficiaries who received counseling at 94 outreach events. Only 29% of beneficiaries with a stand-alone Part D prescription drug plan were enrolled in the lowest-cost plan. On the basis of counseling recommendations, 390 beneficiaries changed to the lowest-cost Part D plan on site, reducing their expected OOP costs by 68%. Additionally, 72 beneficiaries were identified as eligible for but not receiving low-income subsidy benefits and 55 received assistance with the online application for the subsidy. CONCLUSIONS: Findings show that targeted outreach by trained pharmacy advocates can identify vulnerable Medicare populations in need of Part D counseling and reduce their expected annual OOP prescription drug costs.