Although Medicare is a federal program, states have a role to play in providing benefits to Medicare beneficiaries. Besides picking up the tab for some Medicare costs for low-income beneficiaries, many states also operate pharmacy assistance programs that offer help to Medicare beneficiaries. In addition, states will face a major challenge as the new Medicare drug law is implemented and many vulnerable beneficiaries lose Medicaid coverage.
- Visit our Medicare Drug Coverage Center for the latest on the new Medicare prescription drug law.
- Medicare Drug Law Materials for Advocates and Consumers: Click here for a collection of materials produced by Families USA covering different aspects of the new law.
- Health Assistance Partnership (HAP): HAP's mission is to help State Health Insurance Assistance Programs (SHIPs) develop the resources and capacity necessary to deliver education and personalized assistance to Medicare beneficiaries and their caregivers so that they can make informed health care decisions.
Reports and Other Materials
Early Experiences of Medicare Beneficiaries in Prescription Drug Plans: Insights from Medicare State Health Insurance Assistance Program (SHIP) Directors explores early experiences with the Part D drug benefit based on the observations of SHIP directors who work closely with Medicare beneficiaries and CMS. SHIP directors reported problems and concerns relating to enrollment, premium payments, dual eligibles, authorization requirements, data system errors, and the “doughnut hole.” (August 2006) [Kaiser Family Foundation]
Experiences with Medicare Part D: Stories from Low-Income, Ethnically Diverse and Medically Needy Californians examines early experiences with Medicare Part D through in-depth interviews with 35 "vulnerable" Medicare beneficiaries. This is the first of several sets of interviews that will track beneficiary experiences through the first year of Part D operations. The report focuses on choosing and enrolling in Part D plans, as well as using the new prescription drug coverage. (June 2006) [Lake Research Partners and the California Endowment]
The Pharmacy Coverage Safety Net: Variations in State Responses to Supplement Medicare Part D summarizes the findings of two separate surveys of selected state Medicaid and SPAP directors conducted in fall 2005 about state plans for wrapping around gaps in the Part D benefit. The report highlights which gaps states intend to fill and discusses state policy issues and the potential impact on enrollees. (February 2006) [University of Southern Maine]
Before the Medicare drug law was enacted, many states already had programs in place to provide prescription drug coverage to some residents who did not qualify for Medicaid drug coverage. Now, states are trying to figure out whether and how to "wrap around" the new federal benefit in order to fill in coverage gaps. State Pharmacy Assistance Programs: A Chartbook offers policy makers and others comprehensive information on the 38 pharmacy assistance programs now in place, including how these efforts generally compare with the new Medicare drug benefit. (August 2004) [The Commonwealth Fund]
Low-income assistance is one key feature of the Medicare prescription drug bills passed by the House and Senate. State-Level Poverty Data for the Medicare Population includes tables that present national and state-level data on the number of Medicare beneficiaries who may be eligible for additional assistance based on the income eligibility thresholds specified in the House and Senate bills (135 percent, 150 percent, and 160 percent of the federal poverty level). (July 2003) [Kaiser Family Foundation]
State policies play a critical role in shaping women's access to health care. Women's Access to Care: A State-Level Analysis of Key Health Policies details state activity on a range of polices that affect women's access to care, with an emphasis on private coverage, Medicaid, and reproductive health. Specific policies covered in the report include Medicaid eligibility expansions, managed care protections, and assistance with the costs of prescription drugs. (July 2003) [The Kaiser Family Foundation and the National Women's Law Center]
State Health Facts Online, a rich resource of state-specific numbers, has added prescription drug data to their database. These data include statistics on prescription drug use and spending for all 50 states and the U.S. This information is available by age group (seniors, adults, and children) and gender and displayed in ranked tables and color-coded maps. (September 2004) [The Kaiser Family Foundation]
Attorneys General Join Consumers in the Fight for Fair Drug Prices - Statement by Ron Pollack, Executive Director of Families USA (June 4, 2002) [Families USA]
Drug Industry's Deceptive Lobbying at the State Level (March 22, 2002) [Families USA]
States Strive to Limit Medicaid Expenditures for Prescribed Drugs presents trends in Medicaid spending for prescribed drugs through 2000, summarizes the flexibility states have in designing their drug benefits, and reviews several strategies that states are using to curb their Medicaid drug budgets. The brief also makes the point that the "federal government might be able to save the states-and itself-far more money than various state efforts to control utilization and garner additional rebates simply by deploying the program's leverage to ratchet up federal rebates." (February 2002) [The Kaiser Family Foundation]
Florida's Medicaid Prescription Drug Benefit: A Case Study focuses on the state's experience with a number of Medicaid prescription drug cost-control measures. Such measures include a 1997 disease management program, the four-brand drug limit imposed in 2000, and the recent passage of S792, which authorized the development of a preferred drug list. Florida's experience is important because other states are looking at it as a potential model. (February 2002) [The Kaiser Family Foundation]
2001 Prescription Drug Pricing Legislative Summary- In the summer edition of its newsletter Alternatives, the Center for Policy Alternatives has published a prescription drug fair pricing legislative summary for 2001 as part of its compilation of legislative developments in progressive issues. This year, 27 state legislatures introduced fair pricing bills for prescription drugs similar in scope to Maine's landmark law, but more than 40 state legislatures were involved in providing solutions to the problem of escalating prescription drug prices. Those strategies include offering Medicaid prices to seniors, Medicaid waivers, creating or expanding senior pharmacy discount programs, supporting multi-state purchasing alliances, and setting prices at the lowest market rate available. (June 2001) [From the Center for Policy Alternatives]
[Return to top]
For the State Information home page, click here.
For the Across the States page, click here.
For State Information: State Expansions, click here.
For State Information: Medicaid & Children's Health, click here.
For State Information: Related Links, click here.
