This report describes and reviews various options to address prescription drug spending growth, including a description of each cost-containment strategy, its use by private or public payers, and a discussion of known evidence about its effectiveness or cost-saving potential. It was prepared for the Kaiser Family Foundation by Jack Hoadley, Ph.D., of the Health Policy Institute at Georgetown University.

Report (.pdf)

One State’s Medicaid Managed Care Formulary Operations: A Look at Pennsylvania, 2001-2002

This report examines formulary implementation under mandatory Medicaid managed care in Pennsylvania between 2001 and 2002. It looks at one state during a yearlong period; formulary operations are likely to vary across states and programs and over time. The report includes findings about Pennsylvania’s formulary operation and observations about improving the system.

Report (.pdf)

This table highlights changes in the appeal and grievance procedures included in the proposed and final regulations implementing the drug benefit. It was prepared for the Foundation by Sara Rosenbaum, J.D., of the George Washington University School of Public Health.

Issue Brief (.pdf)

This report examines the formulary and cost management provisions of the final Medicare regulations implementing the new Medicare Part D drug benefit that was passed as part of the Medicare Modernization Act of 2003, and their implications for people with Medicare who enroll in new drug plans and their access to medications. It was prepared for the Foundation by Jack Hoadley, Ph.D., of the Health Policy Institute at Georgetown University.

Issue Brief (.pdf)

This issue brief examines the 26 new Medicare Advantage PPO regions and their implications for beneficiaries. The paper describes the characteristics of the new Medicare Advantage regions and the extent to which Medicare Advantage plans are already available in each region. It highlights the substantial gap between the current availability of Medicare Advantage health plans, including Medicare HMOs, PPOs and private fee-for-service plans, throughout the country and that intended for 2006.

Issue Brief (.pdf)

Health Coverage for Low-Income Adults: Eligibility and Enrollment in Medicaid and State Programs, 2002

This policy brief provides new information on the number and characteristics of nonelderly adults eligible for Medicaid and other public coverage and on their enrollment. Because low-income adults often work at jobs that do not offer employer-sponsored coverage and individual coverage is prohibitively expensive for them, their uninsured rates are high. Although Medicaid and the State Children’s Health Insurance Program (SCHIP) serve as a major source of health coverage for children, public coverage of low-income adults lags far behind.

Policy Brief (.pdf)

Generation M2: Media in the Lives of 8-18 Year-olds – Report

The study, Generation M²: Media in the Lives of 8-18 Year-olds, examined media use among a nationally representative sample of more than 2,000 3rd through 12th graders who completed detailed questionnaires, including nearly 700 self-selected participants who also maintained seven-day media diaries.

See the 2010 report

Full Report (.pdf)

Introduction (.pdf)

Section 2: Methods (.pdf)

Section 3: The Household Media Environment (.pdf)

Section 4: Use of Individual Media (.pdf)

Section 5: Overall Media Time (.pdf)

Section 6: Relationship of Media Environment to Media Use (.pdf)

Section 7: Relationship of Media Use to Individual Traits (.pdf)

Section 8: Concluding Comments (.pdf)

Footnotes & References (.pdf)

Appendix 1: Toplines (.pdf)

Appendix 2: Methodology (.pdf)

Appendix 3: Tables on Household Media Environment (.pdf)

Appendix 4: Tables on Individual Media Use (.pdf)

Appendix 5: Tables on Overall Media Use (.pdf)

Appendix 6: Tables on Relationship of Media Environment to Media Use (.pdf)

Appendix 7: Tables on Relationship of Media Use to Individual Traits (.pdf)

Overview and Briefing Charts

This chartpack reviews the President’s FY 2006 budget request to Congress and highlights overall budget assumptions and funding for major health programs. It begins with a description of the federal budget process, followed by an overview of federal surplus/deficit spending patterns dating back to 1969. It then turns to summary information on the overall composition of the Administration’s budget, followed by the President’s proposed funding for some of the major programs administered by the Department of Health and Human Services.

Chartpack (.pdf)

February 25, 2005

For further information contact:Craig Palosky or Sarah Carkhuff: (202) 347-5270

AMERICANS VALUE THE HEALTH BENEFITS OF PRESCRIPTION DRUGS, BUT SAY DRUG MAKERS PUT PROFITS FIRST, NEW SURVEY SHOWS

Public Shows Confidence In The FDA’s AbilityTo Ensure Drug Safety

Americans believe prescription drugs are improving their lives, but most also say that the drug industry cares more about profits than people, according to the latest Kaiser Health Poll Report issued by the Kaiser Family Foundation.

Nearly eight in 10 (78%) adults say that prescription drugs have had a positive impact on the lives of Americans, and nine in 10 (91%) say that drug companies make an important contribution to society by researching and developing new drugs, the new survey finds based on February polling. However, seven in 10 (70%) say drug companies put profits ahead of people, compared with about a quarter (24%) who say drug companies are most concerned with developing new drugs that save lives and improve quality of life.

People also blame drug companies for rising health-care costs. Nearly six in 10 (59%) say prescription drugs increase overall medical costs because they are so expensive – compared with less than one in four (23%) who say drugs lower medical costs by reducing the need for expensive medical procedures and hospitalizations. These results are consistent with an earlier poll showing that people are now more likely to cite drug company profits as the major cause of rising health-care costs than any other cause – with 69% of people saying it is a “very important” factor, including 24% saying it is “the most important factor.” More people cited drug company profits as the most important factor than cited greed and waste in the health-care system (20%), the number of malpractice lawsuits (20%), the aging of the population (7%) or the use of expensive, high-tech medical equipment and treatments (7%).

“Rightly or wrongly, drug companies are now the number one villain in the public’s eye when it comes to rising health-care costs,” said Foundation President Drew E. Altman, Ph.D. “People want to rein in the cost of prescription drugs, and just about anything we poll on with that aim gets public support.”

Overall, one half (50%) of all Americans say they have an unfavorable view of drug companies, while 44% say they have a favorable opinion. Drug companies are viewed more favorably than oil companies (36% favorable) and tobacco companies (17%), but less than doctors (82% favorable), hospitals (78%) and banks (75%).

The survey’s other key findings include:

• Americans express confidence in the ability of the U.S. Food and Drug Administration (FDA) to ensure the safety of prescription drugs, with about three-quarters (77%) of adults saying they are “very” (22%) or “somewhat” (55%) confident in the FDA’s ability to ensure drug safety. Just over two in 10 (22%) say they are “not too” or “not at all” confident in the FDA. When asked about the past few years, six in 10 (62%) say that their confidence in the FDA’s ability to ensure safety has “remained the same;” while 27% say their confidence has decreased; and 8% say their confidence has increased.“Recent controversy over the safety of a few popular drugs has yet to shift public perception of the FDA,” said Mollyann Brodie, Ph.D., Foundation Vice President and Director of Public Opinion and Media Research. “Most people continue to express confidence in the FDA’s ability to ensure the safety of prescription drugs.”
• Almost two-thirds (65%) say there should be more government regulation limiting the price of prescription drugs, compared with 14% who say there is too much regulation. Nearly half (46%) of all adults continue to support more regulation of prices even if they heard that it might lead to less research and development of new drugs, while 15% would switch to oppose more regulation after hearing this argument.
• In 2005, most adults (90%) have seen or heard advertisements for prescription medications, up from 2000 when about three in four adults (76%) said they had seen drug ads. Just over one-quarter of people who have seen drug ads (26%, or 23% of all adults) say they have talked to a doctor about a specific prescription medication as a result of an advertisement. Of those who talked to a doctor as a result of an ad, three out of four (75%, or 18% of all adults) say they received a prescription for either the advertised drug or another drug as a result.
• About half say there should be more regulation of drug advertising (51%) and drug safety (50%). These shares have increased since 2000 when just over one-third said there should be more regulation of drug advertising (37%) and drug safety (36%).
• Half (50%) of U.S. adults report taking a prescription drug daily.

  Prescription drugs account for a modest but rapidly growing share of the nation’s health-care expenses. In 2003, the nation spent an estimated $179 billion on prescription drugs, nearly 11% of all health-care spending in the U.S. Since 1993, prescription drug spending has increased faster each year than spending on hospitals or physician services.

  The new survey data on attitudes toward drugs and the pharmaceutical industry comes from the latest Kaiser Health Poll Report, a bi-monthly tracking poll that captures the public’s views on health-care issues. The survey of 1,201 U.S. adults was conducted from Feb. 3-6.

  The current report’s featured topic analyzes the new data, as well as related polling information from earlier surveys by Kaiser and other organizations. The full report is available at www.kff.org/healthpollreport/feb_2005/.

  METHODOLOGY

  The Kaiser Family Foundation Health Poll Report Survey was designed and analyzed by researchers at the Kaiser Family Foundation. Fieldwork was conducted by telephone by Princeton Survey Research Associates International between February 3 and February 6, 2005, among a nationally representative random sample of 1,201 adults ages 18 and older. The margin of sampling error for the survey is plus or minus 3 percentage points for total respondents. For results based on smaller subsets of respondents the margin of sampling error is higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll.

  # # #

  The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The foundation is not associated with Kaiser Permanente or Kaiser Industries.

• What rules apply to states implementing the BBA eligibility group?
• Can a state impose additional requirements?
• What are the basic Medicaid buy-in provisions in TWWIIA?
• Who qualifies for coverage under the basic coverage group?
• What rules apply to states implementing the TWWIIA basic coverage group?
• Who qualifies for coverage as part of the medical improvement group?
• What rules apply to states implementing the medical improvement group?
• Can a state that has a TWWIIA Medicaid buy-in impose additional requirements?
• Can a person resume receiving SSI cash benefits if you are not able to work any longer?
• How to contact Medicaid in your state

Under federal law, states have the option of creating Medicaid buy-in programs that enable employed individuals with disabilities who make more than what is allowed under Section 1619(b) to obtain Medicaid coverage at a low or no cost. A state has 3 distinct ways that it can create and offer a Medicaid buy-in under two separate federal laws – the Balanced Budget Act (the BBA) and Ticket to Work and Work Incentives Improvement Act (TWWIIA). In brief, these provisions provide for the following:

The BBA Medicaid Buy-In – Allows a state to offer Medicaid coverage to any employed person with a disability who has a net family income below 250 percent of the Federal poverty level for a family of the size involved.

TWWIIA Medicaid Buy-In Provisions – TWWIIA allows a state to offer Medicaid coverage to individuals who fall into one of the following groups:

(1) Basic Coverage Group. States have the option to offer Medicaid to working individuals who are at least 16 but less than 65 years of age who, except for their income and resource levels, are eligible to receive SSI. States are free to establish their own income and resource standards. Individuals who have never received SSI benefits can be eligible.

(2) Medical Improvement Group. States have the option to offer Medicaid to employed individuals with a medically improved disability who lose Medicaid eligibility under the group described above because they no longer meet the SSI definition of disability.

States offering coverage to the second group must also cover the first group. States may impose premiums or other cost-sharing charges on a sliding scale based on income for individuals eligible for either of the new eligibility groups.

As of September 2004, a total of 25 states offered a Medicaid buy-in to working age people with disabilities who are eligible for coverage under one or more of the 3 options just described. For information about eligibility policies in specific states, go to http://www.cms.hhs.gov/twwiia/statemap.asp. If you have determined that there is buy-in program in your state for which you may qualify, you should contact the Medicaid program in your state for more information. Back to the Top

What rules apply to states implementing the BBA eligibility group?

The following rules must be adhered to in each state that offers this form of Medicaid buy-in:

• Family Income Standard – Net family income below 250 percent of the Federal poverty level for a family of the size involved.
• Except for earned income (which is completely disregarded) the individual must meet all SSI eligibility criteria, including:
  • Unearned income not exceeding the SSI income standard (currently $599 a month for an individual; $889 for a couple in 2005).
  • Resources not exceeding SSI resource standard ($2,000 for an individual; $3,000 for a couple in 2005).
  • Disabled as defined under the SSI program.
  • SSI income and resource methodologies are used to determine eligibility. Back to the Top

Can a state impose additional requirements?

Yes. A state with a BBA Medicaid buy-in can also:

• Use more liberal income and resource methodologies than are typically used by SSI.
• Use more restrictive eligibility criteria than are used by SSI (209(b) States).
• Require payment of such premiums or other cost-sharing charges, on a sliding scale based on income, as the State may determine. Back to the Top

What are the basic Medicaid buy-in provisions in TWWIIA?

These provisions were approved by Congress to build and expand on the buy-in option available under the BBA. TWWIIA created two additional optional categorically needy Medicaid buy-in eligibility groups: (1) the Basic Coverage Group; and (2) the Medical Improvement Group. Back to the Top

Who qualifies for coverage under the basic coverage group?

The Basic Coverage Group is similar to the BBA group, however states can establish their own income and resource standards (or choose to not have any income or resource standards), and there is an age limit (at least 16 but not more than 64 years of age). Back to the Top

What rules apply to states implementing the TWWIIA basic coverage group?

States implementing this provision must ensure that:

• Individuals covered must be between 16 and 64 years of age.
• Individuals covered must meet the SSI definition of disability.
• Earned income is not automatically disregarded.
• No federally required income and resource standards.
• If States establish income and resource standards, SSI income and resource methodologies are used to determine eligibility. Back to the Top

Who qualifies for coverage as part of the medical improvement group?

Under this option, a state can offer Medicaid to employed individuals with a medically improved disability who lose Medicaid eligibility under the group described above because they no longer meet the SSI definition of disability. It is important to note that States offering coverage to the second group must also cover the first group. Back to the Top

What rules apply to states implementing the medical improvement group?

States implementing this provision must ensure that:

• Individuals covered must be between 16 and 64 years of age.
• Individual covered must have a medically improved disability.
• Individual covered must have been eligible under the Basic Coverage Group but lost that eligibility because his or her medical condition has improved to the point where it is determined at the time of a regularly scheduled continuing disability review that he or she is no longer disabled as SSI defines the term.
• Earned income is not automatically disregarded.
• No federally required income and resource standards.
• If States establish income and resource standards, SSI income and resource methodologies are used to determine eligibility. Back to the Top

Can a state that has a TWWIIA Medicaid buy-in impose additional requirements?

Yes, it can:

• Establish their own income and resource standards, or have no income and resource standards if they choose.
• Use more liberal income and resource methodologies than are typically used by SSI.
• Use more restrictive eligibility criteria than are used by SSI (209(b) States).
• Require payment of such premiums or other cost-sharing charges, on a sliding scale based on income, as the State may determine.
• Impose premiums or other cost-sharing charges on a sliding scale based on income for individuals eligible for either of the new eligibility groups.

To obtain information on TWWIIA Medicaid buy-in requirements that have been set by your state, you can contact your state Medicaid agency (see the table on the next page or consult the Centers on Medicare and Medicaid Services website at http://www.cms.hhs.gov/twwiia/statemap.asp. Back to the Top

Can a person resume receiving SSI cash benefits if you are not able to work any longer?

Yes. If you have not been eligible for an SSI benefit for 12 months or less, you do not have to file a new application to reinstate your SSI cash payments or Medicaid coverage. If you stop working after more than 12 months you will have to apply for the benefits again but provided that your disability has not improved regaining them should not be an issue. Back to the TopHow to Contact Medicaid in Your State