Value, 2006

AARP

February 2006

AARP has used findings from AHRQ-sponsored research to advocate for expanded prescription drug coverage for low-income persons and against restrictions on prescription drug coverage. David Gross, until recently a Senior Policy Advisor with AARP's Public Policy Institute and currently Manager of Health and Supportive Services with AARP's Outreach and Service Department, called the work of AHRQ researcher Stephen B. Soumerai and colleagues a "landmark study."

Gross reported that AARP has recently used the Soumerai study in its advocacy efforts against curtailment of drug coverage in the TennCare program, Tennessee's Medicaid managed care program. AARP attorneys also called Soumerai as a witness in a federal court trial that, among other things, challenged the state's proposal to cap TennCare drug coverage at two brand drugs and five drugs overall each month.

The AHRQ-funded study conducted by Soumerai and colleagues found that after the New Hampshire Medicaid program imposed a reimbursement cap of three medications per month, standard doses of essential medications among New Hampshire Medicaid beneficiaries over age 60 with chronic illness fell by 34 percent. Hit especially hard by the cap were those who had a greater number of precap medications, greater number of coexisting illnesses, longer hospitalizations, and greater use of outpatient services. Soumerai and colleagues concluded that arbitrary drug limits clearly reduce use of necessary medications by the frailest community-dwelling older people which may, in turn, lead to increased hospitalizations or nursing home admissions.

Previously, AARP had used the study in advocacy to provide or expand prescription drug coverage for low-income persons in New York, Massachusetts, Wisconsin, Texas, Illinois, and other states. In addition, the study has been cited in several policy papers prepared by the AARP Public Policy Institute that discuss the impacts of inadequate prescription drug coverage on low-income consumers.

Impact Case Study Identifier: COE 06-03
AHRQ-Sponsored Activity: Research
Topic(s): Prescription Drugs, Low-income
Scope: Illinois, Maine, New York, Tennessee, Texas, Wisconsin

Fortress EE, Soumerai SB, McLaughlin TJ, and Ross-Degnan D. Utilization of essential medications by vulnerable older persons after a drug benefit cap: Importance of mental disorders, chronic pain, and practice setting. Journal of the American Geriatrics Society 2001; 49(6):793-97. (HS05947)

Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris C, and Bollini P. Effects of limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. New England Journal of Medicine 1994; 331:650-655. (HS05947)

Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin TJ, and Choodnovskiy I. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. New England Journal of Medicine 1991; 325(15):1072-1077. (HS05947)

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