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Health Affairs has issued a special collection of articles about costs and utilization of prescription drug insurance coverage. In one article, authors Bruce Stuart, Dennis Shea, and Becky Briesacher investigate not only the number of Medicare beneficiaries who have insurance that pays for drug costs, but also the number of people who have had changes in their drug coverage. They found that over half the Medicare beneficiaries had some sort of interruption in their drug coverage from 1995 to 1996. These people are categorized into "finders" -- those who started out without coverage but found it by the end of the two year period and "losers" -- those who started out with coverage and lost it. Many others had coverage provided by one or more different providers over this time period.

The authors found that the people most likely to have lost coverage for prescription drugs during the two year period of the study were older people living in the midwest or in rural areas, those most likely to have added coverage when they didn't have it initially were younger people living in the west. They found that people living in states with prescription drug coverage plans were most likely to have had continuous coverage for prescription drugs, and, not surprisingly, low income people who qualified for public benefits (usually Medicaid) were also likely to have had continuous coverage. Since the highest income people generally had continuous coverage, the group most likely to lack coverage were middle income seniors.

The authors contend that all this instability is a strong argument for making drug coverage a regular part of the Medicare program. Data is probably not yet available to do so, but it would be quite interesting to see how patterns have changed since 1996, considering the turmoil in Medicare HMOs that forced about 2 million Medicare beneficiaries to find new plans from 1998-2000 and the huge increases in drug and insurance costs since that time.

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