PDB88 - Impact of medicare part d: Comparison of health care expenditures and utilization for medicare patients with diabetes

Abstract

To compare overall and diabetes-related health care utilization and expenditures in Medicare beneficiaries with diabetes prior to and after implementation of Part D. Data were from the 2001-2010 Medical Expenditure Panel Survey. Medicare beneficiaries aged ≥65 years with self-reported diabetes were identified, excluding individuals who were Medicare-Medicaid dual eligible, had TRICARE, or other public coverage. The outcomes included overall and diabetes-related prescriptions, medical services utilization, and expenditures as well as out-of-pocket costs. These outcomes were analyzed using generalized linear model regression models with a log-link and gamma (for costs) or Poisson (utilization) distribution. All expenditures were inflated to 2010 dollars. STATA survey commands were used to account for the complex survey design. There were 21,864 eligible Medicare beneficiaries with diabetes that comprised the sample population. After adjusting for sociodemographic characteristics and health status, implementation of Part D was associated with decreased out-of-pocket expenditures for insulin (Coeff.: -0.577, p<0.05) and oral antidiabetic agents (Coeff.:-1.292, p<0.001). No statistically significant effect on total health care and prescription expenditures were found. Implementation of Part D was associated with increased number of prescriptions filled (Coeff.: 0.145, p< 0.001) without increase in emergency room visits or inpatient stays. The implementation of Medicare Part D increased medication use and reduced out-of-pocket costs for elderly diabetes patients. This reduction would allow for enhanced access to necessary medications, and thereby may have a positive impact on adherence and health outcomes.