title: Compliance among pharmacies in California with a prescription-drug discount program for Medicare beneficiaries.
abstract: BACKGROUND
  Several states have developed prescription-drug discount programs for Medicare beneficiaries. In California, Senate Bill 393, enacted in 1999, requires pharmacies participating in the state Medicaid program (Medi-Cal) to charge customers who present a Medicare card amounts based on Medi-Cal rates. Because Medicare beneficiaries may not be accustomed to presenting their Medicare cards at pharmacies, we assessed the compliance of pharmacies with Senate Bill 393.
  
  
  METHODS
  Fifteen Medicare beneficiaries who received special training and acted as "standardized patients" visited a random sample of pharmacies in the San Francisco Bay area and Los Angeles County in April and May 2001. According to a script, they asked for the prices of three commonly prescribed drugs: rofecoxib, sertraline, and atorvastatin. The script enabled us to determine whether and when, during their interactions with pharmacists or salespeople, the discounts specified in Senate Bill 393 were offered. Pharmacies at which the appropriate discounts were offered were considered compliant.
  
  
  RESULTS
  The patients completed visits to 494 pharmacies. Seventy-five percent of the pharmacies complied with the prescription-drug discount program; at only 45 percent, however, was the discount offered before it was specifically requested. The discount was offered at 91 percent of pharmacies that were part of a chain, as compared with 58 percent of independent pharmacies (P<0.001). Compliance was higher in the San Francisco Bay area than in Los Angeles County (84 percent vs. 72 percent, P=0.004) and was higher in high-income than low-income neighborhoods (81 percent vs. 69 percent, P=0.002). A Medicare beneficiary taking all three drugs would have saved an average of $55.70 per month as compared with retail prices (a savings of 20 percent).
  
  
  CONCLUSIONS
  Discounts required under California's prescription-drug discount program for Medicare beneficiaries offer substantial savings. Many patients, however, especially those who use independent pharmacies or who live in low-income neighborhoods, may not receive the discounts.
authors.affiliation: RAND Health, Santa Monica, Calif 90407-2138, USA. joys@rand.org
authors.forename: Joy H
authors.initials: JH
authors.lastname: Lewis
authors.forename: Matthias
authors.initials: M
authors.lastname: Schonlau
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Muñoz
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Mayde R
authors.initials: MR
authors.lastname: Rosen
authors.forename: Hannah
authors.initials: H
authors.lastname: Yang
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics; D000924:Anticholesteremic Agents / Q000191:economics; D000928:Antidepressive Agents / Q000191:economics; D000069059:Atorvastatin; D002140:California; D017046:Cost Savings; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics*; D005102:Health Expenditures / Q000639:trends; D006538:Heptanoic Acids / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence*; D007783:Lactones / Q000191:economics; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence; D011306:Prescription Fees / Q000331:legislation & jurisprudence* / Q000592:standards; D011758:Pyrroles / Q000191:economics; D020280:Sertraline / Q000191:economics; D013450:Sulfones; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000924:Anticholesteremic Agents; D000928:Antidepressive Agents; D006538:Heptanoic Acids; D007783:Lactones; D011758:Pyrroles; D013450:Sulfones; C116926:rofecoxib; D000069059:Atorvastatin; D020280:Sertraline