Iowa Medicare beneficiaries' satisfaction and experiences with a prescription drug discount card and preferred drug list

Objective: To evaluate the expectations, experiences, and satisfaction with the Iowa Priority Prescription Savings (IPPS) program. Design: Longitudinal descriptive study. Setting: Iowa. Participants: Randomly selected Iowa Medicare beneficiaries who self-enrolled in the IPPS prescription discount card program. Interventions: Three self-administered surveys mailed in November 2002, June 2003, and September 2004, during the first, second, and third years of IPPS operation. Main Outcome Measures: Expectations of drug discounts, amount of discounts received, awareness of the IPPS preferred drug list (PDL), and satisfaction with the program. Results: Usable response rates for the three surveys were 43.5%, 31.0%, and 38.4%. About one fourth of members initially expected discounts of more than 20% on their prescription medications. After IPPS was implemented, many members were unaware of the discounts they were receiving, but the percentage of members reporting discounts of more than $20 per month increased from 7.4% in year 1 to 16.4% in year 3. More than one half of the members were unaware of which drugs were on the PDL in years 1 and 2, but this improved to 21% unawareness in year 3. Satisfaction with the program was low but improved over time. Members who received discounts, did not expect large discounts, or received a medication review were more satisfied with the program. Conclusion: Some IPPS members had unrealistic expectations about the amount of discounts they would receive, and expectations of large discounts decreased satisfaction. Satisfaction and amount of discounts improved over time, and beneficiaries whose medications were reviewed, usually by a pharmacist, were more satisfied with the program. PDL awareness was a problem despite substantial educational efforts by IPPS, a finding that has implications for the recently implemented Medicare Part D drug benefit.