Medicare Prescription Drug Benefit Research Articles

Estimating the Impact of the Inflation Reduction Act on the Out-of-pocket Costs for Medicare Beneficiaries With Advanced Prostate Cancer.

Combination systemic therapy for advanced prostate cancer has reduced mortality, but high out-of-pocket costs impose financial barriers for patients. The Inflation Reduction Act's $2,000 out-of-pocket spending cap for Medicare's prescription drug benefit (Part D) can potentially lower out-of-pocket spending for beneficiaries starting in 2025. This study aims to compare out-of-pocket spending for commonly prescribed regimens for advanced prostate cancer before and after implementation of the Inflation Reduction Act. Medication regimens constructed to treat metastatic, hormone-sensitive prostate cancer consisted of baseline androgen deprivation therapy with traditional chemotherapy, androgen receptor inhibitors, and androgen biosynthesis inhibitors. Using 2023 Medicare Part B prices and the Medicare Part D plan finder, we estimated annual out-of-pocket costs under current law and under the Inflation Reduction Act's redesigned standard Part D benefit. Under current law, out-of-pocket costs for Part D drugs ranged from $464 to $11,336 per year. Under the Inflation Reduction Act, annual out-of-pocket costs for 2 regimens remained unchanged: androgen deprivation therapy with docetaxel and androgen deprivation therapy with abiraterone and prednisone. However, out-of-pocket costs for regimens using branded novel hormonal therapy were significantly lower under the 2025 law with potential savings estimated to be $9,336 (79.2%) for apalutamide, $9,036 (78.7%) for enzalutamide, and $8,480 (76.5%) for docetaxel and darolutamide. The $2,000 spending cap introduced by the Inflation Reduction Act may significantly decrease out-of-pocket costs and reduce financial toxicity associated with advanced prostate cancer treatment, impacting an estimated 25,000 Medicare beneficiaries.

CMS Finalizes New Medicare Advantage Prior Authorization Rule

CMS Finalizes New Medicare Advantage Prior Authorization Rule

The Centers for Medicaid & Medicare Memo: What Does it Mean for Long-term Care Pharmacy in Part D?

Paul Baldwin discusses the December 15, 2020 release of a CMS memo aimed at Medicare Part D sponsors. The thrust of the memo was to explain the agency's current interpretation of appropriate dispensing fees under the provisions of CMS regulations concerning the Medicare Prescription Drug Benefit. The focus of this memo is how the LTC Guidance (Prescription Drug Benefit Manual Chapter 5. 50.5) would apply across the spectrum of pharmacy providers and Medicare beneficiaries.

PDB29 Medication Non-Adherence and Health Literacy Among Medicare Beneficiaries with Type 2 Diabetes

Medication non-adherence can lead to poor glycemic control and worsen health outcomes for individuals with diabetes. Evidence on the impact of health literacy on medication non-adherence is sparse. We examined the relationship between health literacy and medication non-adherence among Medicare beneficiaries with type 2 diabetes. We analyzed the 2018 Medicare Current Beneficiary Survey Public Use File, a nationally representative sample comprised of Medicare beneficiaries aged ≥ 65 years with reported type 2 diabetes (n=919). Medication non-adherence (outcome variable) was constructed as binary, and three main independent variables were recoded and created as follows: (1) whether the Medicare prescription drug benefit was easy/difficult to understand (binary); (2) whether providers gave instructions on how to take care of one’s health (binary); and (3) whether providers provided medication-related information (categorical). The third variable contained 4 categories and measured whether medical providers talked with beneficiaries about how to take medication and what to do with adverse reactions. A survey-weighted logistic model, adjusted for socio-demographics and co-morbidities, was performed to examine associations between medication non-adherence and the three variables. Approximately 19.6% (n=150) of Medicare beneficiaries reported medication non-adherence. Beneficiaries who reported they easily understood the prescription drug benefit were less likely to report non-adherence, compared to their counterparts (odds ratio (OR)=0.31, p<0.001). Beneficiaries who reported providers gave instructions on how to take care of one’s health were not significantly associated with medication non-adherence. Beneficiaries who reported providers talked to them about how to take medication and what to do with adverse reactions were less likely to report medication non-adherence, compared to those who reported providers did not talk about both information (OR=0.46, p=0.028). Improved comprehension of medication literacy may improve medication non-adherence among Medicare beneficiaries with type 2 diabetes. Healthcare providers could play a critical role in helping this at-risk population.

Nationwide estimates of medication therapy management delivery under the Medicare prescription drug benefit

ObjectiveTo describe the national delivery of medication therapy management (MTM) to Medicare beneficiaries in 2013 and 2014. MethodsDescriptive cross-sectional study using the 100% sample of 2013 and 2014 Part D MTM data files. We quantified descriptive statistics (counts and percentages, in addition to means and standard deviations) to summarize the delivery of these services and compare delivery between 2013 and 2014. ResultsMedicare beneficiaries eligible for MTM increased from 4,281,733 in 2013 to 4,552,547 in 2014. Among eligible beneficiaries, the number and percentage who were offered a comprehensive medication review (CMR) increased from 3,473,004 (81.1%) to 4,394,822 (96.5%), and beneficiaries receiving a CMR increased from 526,203 (12.3%) to 767,286 (16.9%). In 2014, CMRs were most frequently delivered by telephone (83.2%) and provided by either a plan sponsor (29.0%) or an MTM vendor in-house pharmacist (35.0%). In 2014, pharmacists provided 93.5% of all CMRs, and other providers (e.g., nurses and physicians) provided 6.5% of CMRs. Few patients who received a CMR received more than 1 within the same year (2.2% in 2014). Medication therapy problem (MTP) resolution among patients receiving a CMR stayed roughly the same between 2013 and 2014 (19.2% vs. 18.7%, respectively; P < 0.001). Finally, most beneficiaries (96.9% in 2014) received a targeted medication review, regardless of whether a CMR was offered or provided. ConclusionMore than 4 million Medicare beneficiaries were enrolled in Part D MTM in both 2013 and 2014. However, less than 20% of eligible beneficiaries received a CMR during those years, and rates of MTP resolution were low. Future evaluation of Part D MTM delivery should examine changes in eligibility criteria and delivery over time to inform MTM policy and changes in practice.

Risk-Sharing in Retiree Medical Benefits

Retiree medical care expenditures in the United States are growing at a rapid rate, while and the retired portion of the population is increasing. This puts pressure on government and employer programs providing retiree health care coverage. Retirees also face increasing challenges in gaining access to affordable coverage, particularly before eligibility for Medicare. In this chapter we assess prospects for US retiree health coverage and the challenges, risks, and roles of employers, Medicare, and retirees in providing and financing it. We discuss both traditional approaches to retiree health benefits, where the employer assumes most risk, and new defined contribution approaches, where significant risk is shifted to the retiree. We also review government benefits for retirees including new Medicare prescription drug benefits. We model future retiree health care costs and opportunities to save before retiring, highlighting public policy obstacles and issues for employer-provided retiree health benefits.

Coverage of Novel Therapeutic Agents by Medicare Prescription Drug Plans Following FDA Approval.

Regulatory approval of novel therapies by the FDA does not guarantee insurance coverage requisite for most clinical use. In the United States, the largest health insurance payer is the Centers for Medicare & Medicaid Services (CMS), which provides Part D prescription drug benefits to over 43 million Americans. While the FDA and CMS have implemented policies to improve the availability of novel therapies to patients, the time required to secure Medicare prescription drug benefit coverage-and accompanying restrictions-has not been previously described. To characterize Medicare prescription drug plan coverage of novel therapeutic agents approved by the FDA between 2006 and 2012. This is a cross-sectional study of drug coverage using Medicare Part D prescription drug benefit plan data from 2007 to 2015. Drug coverage was defined as inclusion of a drug on a plan formulary, evaluated at 1 and 3 years after FDA approval. For covered drugs, coverage was categorized as unrestrictive or restrictive, which was defined as requiring step therapy or prior authorization. Median coverage was estimated at 1 and 3 years after FDA approval, overall, and compared with a number of drug characteristics, including year of approval, CMS-protected class status, biologics versus small molecules, therapeutic area, orphan drug status, FDA priority review, and FDA-accelerated approval. Among 144 novel therapeutic agents approved by the FDA between 2006 and 2012, 14% (20 of 144) were biologics; 40% (57 of 144) were included in a CMS-protected class; 31% (45 of 144) were approved under an orphan drug designation; 42% (60 of 144) received priority review; and 11% (16 of 144) received accelerated approval. The proportion of novel therapeutics covered by at least 1 Medicare prescription drug plan was 90% (129 of 144) and 97% (140 of 144) at 1 year and 3 years after approval, respectively. At 3 years after approval, 28% (40 of 144) of novel therapeutics were covered by all plans. Novel therapeutic agents were covered by a median of 61% (interquartile range [IQR] = 39%-90%) of plans at 1 year and 79% (IQR = 57%-100%) at 3 years (P < 0.001). When novel therapeutics were covered, many plans restricted coverage through prior authorization or step therapy requirements. The median proportion of unrestrictive coverage was 29% (IQR = 13%-54%) at 3 years. Several drug characteristics, including therapeutic area, FDA priority review, FDA-accelerated approval, and CMS-protected drug class, were associated with higher rates of coverage, whereas year of approval, drug type, and orphan drug status were not. Most Medicare prescription drug plans covered the majority of novel therapeutics in the year following FDA approval, although access was often restricted through prior authorization or step therapy and was dependent on plan choice. Funding for this study was contributed by a student research grant awarded to Shaw and provided by the Yale School of Medicine Office of Student Research under National Institutes of Health training grant award T35DK104689. Ross reports research grants to Yale University from the U.S. Food and Drug Administration (U01FD005938, U01FD004585), Medtronic, Johnson & Johnson, Centers for Medicare & Medicaid Services (HHSM-500-2013-13018I), Blue Cross-Blue Shield Association, Laura and John Arnold Foundation, Agency for Healthcare Research and Quality (R01HS022882), and National Institutes of Health (R01HS025164), unrelated to this study. Dhruva has nothing to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Medicare's Variation in Out-of-Pocket Costs for Prescriptions: The Irrational Examples of In-Hospital Observation and Home Infusion.

The Medicare program pays for prescription drugs using several different-and often complicated-methods. As hospital-based treatment continues to shift from inpatient care to outpatient observation status, and as intravenous infusions continue to shift from hospitals and provider offices into the home, understanding Medicare's prescription drug benefits is increasingly confusing to providers and beneficiaries. Not only is it sometimes difficult to determine whether coverage is provided under Medicare Part A, Part B, or Part D, but this determination also has consequences for Medicare beneficiaries' out-of-pocket spending, which may be higher in certain situations. Although Medicare may be a single payer, the "system" of payment varies depending on where beneficiaries receive treatment; what their income and assets are; whether they are receiving inpatient, outpatient, or hospice services; and whether they are enrolled in original Medicare or a Medicare Advantage managed care plan. Policies are needed to address these anomalies in the design of Medicare prescription drug benefits and reduce the unjustified variation in out-of-pocket costs. J Am Geriatr Soc 66:2249-2253, 2018.

Reflections on Bipartisan Solutions to Addressing Poverty.

This reflection on the Medicalization of Poverty asks how healthcare itself plays a role in the development of poverty. Drawing on Governor Thompson's extensive work reforming the welfare system, the reflection first stresses the importance of involving the very people impacted by any reform - a conscious process Governor Thompson used when pioneering the W-2 program in Wisconsin and then extended to the overhaul of Medicare's prescription drug benefit. Second, it stresses the advantage of developing bipartisan solutions to solve hard problems such as how best to provide affordable healthcare and reduce poverty in the lives of Americans.

Association of high cost sharing and targeted therapy initiation among elderly Medicare patients with metastatic renal cell carcinoma.

High out‐of‐pocket costs may limit access to oral therapies covered by patients’ prescription drug benefits. We explored financial barriers to treatment initiation in patients newly diagnosed with metastatic renal cell carcinoma (mRCC) by comparing Medicare Part D patients with low out‐of‐pocket costs due to receipt of full low‐income subsidies (LIS beneficiaries) to their counterparts who were responsible for more than 25% cost sharing during Medicare's initial coverage phase (non‐LIS beneficiaries). We used 2011–2013 100% Medicare claims for non‐LIS and LIS beneficiaries newly diagnosed with metastases in the liver, lung, or bone to examine targeted therapy treatment initiation rates and time to initiation for (1) oral medications (sorafenib, sunitinib, everolimus, pazopanib, or axitinib) covered under Medicare's prescription drug benefit (Part D); (2) injected or infused medications (temsirolimus or bevacizumab) covered by Medicare's medical benefit (Part B); and (3) any (Part D or Part B) targeted therapy. The final sample included 1721 patients. On average, non‐LIS patients were responsible for out‐of‐pocket costs of ≥$2,800 for their initial oral prescription, as compared to ≤$6.60 for LIS patients. Compared to LIS patients, a lower percentage of non‐LIS patients initiated oral therapies (risk‐adjusted rates, 20.7% vs. 33.9%; odds ratio [OR] = 0.49, 95% CI: 0.36–0.67, P < 0.001) and any targeted therapies (26.7% vs. 40.4%, OR = 0.52, 95% CI: 0.38–0.71, P < 0.001). Non‐LIS patients were also slower to access therapy. High cost sharing was associated with reduced and/or delayed access to targeted therapies under Medicare Part D, suggesting that financial barriers play a role in treatment decisions.

The impact of Medicare Part D on cognitive functioning at older ages

Research has shown that the establishment of Medicare prescription drug benefit in 2006 leads to improvement in medication adherence and mortality outcomes. Despite a clear connection between physical/mental health and the risk of dementia, little is known about the extent to which this reform has affected the cognitive functioning of the elderly. Using data from the Health and Retirement Study and difference-in-differences approach, this study provides the first evidence on the cognition-enhancing effects of Medicare Part D. Our estimates show that Part D implementation is associated with 1.6% increase in cognitive functioning or 1.1-year delay of cognitive aging among benefit-eligible persons. Further analyses indicate that most of the cognitive benefits accrue to the vulnerable populations who previously lacked prescription drug coverage, and that a reduction in cardiovascular mortality is the most likely pathway through which the expansion improved cognitive functioning.

Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma

ABSTRACTBackground: Asthma is one of the most frequently targeted chronic diseases in the medication therapy management (MTM) programs of the Medicare prescription drug (Part D) benefits. Although racial and ethnic disparities in meeting eligibility criteria for MTM services have been reported, little is known about whether there would be similar disparities among adults with asthma in the United States. Methods: Adult patients with asthma (age ≥ 18) from Medical Expenditure Panel Survey (2011–2012) were analyzed. Bivariate analyses were conducted to compare the proportions of patients who would meet Medicare MTM eligibility criteria between non-Hispanic Blacks (Blacks), Hispanics and non-Hispanic Whites (Whites). Survey-weighted logistic regression was performed to adjust for patient characteristics. Main and sensitivity analyses were conducted to cover the entire range of the eligibility thresholds used by Part D plans in 2011–2012. Results: The sample included 4,455 patients with asthma, including 2,294 Whites, 1,218 Blacks, and 943 Hispanics. Blacks and Hispanics had lower proportions of meeting MTM eligibility criteria than did Whites (P < 0.001). According to the main analysis, Blacks and Hispanics had 36% and 32% lower, respectively, likelihood of MTM eligibility than Whites (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.45–0.90; OR: 0.68, 95% CI: 0.47–0.98, respectively). Similar results were obtained in sensitivity analyses. Conclusions: There are racial and ethnic disparities in meeting Medicare Part D MTM eligibility criteria among adult patients with asthma. Future studies should examine the implications of such disparities on health outcomes of patients with asthma and explore alternative MTM eligibility criteria.

How Increasing Medical Access to Opioids Contributes to the Opioid Epidemic: Evidence from Medicare Part D

Drug overdoses involving opioid analgesics have increased dramatically since 1999, representing one of the United States’ top public health crises. Opioids have legitimate medical functions, but improving access may increase abuse rates even among those not prescribed the drugs given that opioids are frequently diverted to nonmedical use. We have little evidence about the causal relationship between increased medical access to opioids and spillovers resulting in abuse. We use the introduction of the Medicare Prescription Drug Benefit Program (Part D) as a large and differential shock to the geographic supply of opioids. We compare growth in opioid supply and abuse rates in states with large 65+ population shares to states with smaller elderly population shares with a focus on abuse among the Medicare-ineligible population. Part D increased opioid utilization for the 65+ population, and we show that this increase in utilization led to significant growth in the overall supply of opioids in high elderly share states relative to low elderly share states. This relative expansion in opioid supply resulted in an escalation in opioid-related substance abuse treatment admissions and opioid-related mortality among the Medicare-ineligible population, implying meaningful spillovers to individuals who did not experience any change in prescription drug benefits. The evidence suggests that increased opioid supply is associated with economically-important levels of diversion for nonmedical purposes. Our estimates imply that a 10% increase in medical opioid distribution leads to a 7.4% increase in opioid-related deaths and a 14.1% increase in substance abuse treatment admission rates for the Medicare-ineligible population.

Bang Your Head Here! Strategies to Survive in the World of Medicare Part D (TH308)

Objectives Recognize the current climate that has developed between Medicare Part D and hospice. Describe methods of medication reconciliation across hospital and hospice settings. Describe methods of medication discontinuation. Medicare Part D, also called the Medicare prescription drug benefit, is a federal program subsidizing the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries in the United States. Enacted as part of the Medicare Modernization Act of 2003, it went into effect January 1, 2006. With increasing regulation of hospice, recent announcements

MP78-04 ORAL AND INTRAVENOUS BISPHOSPHONATE USE FOLLOWING ANDROGEN DEPRIVATION THERAPY AMONG MEDICARE BENEFICIARIES WITH NON-METASTATIC PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History III1 Apr 2014MP78-04 ORAL AND INTRAVENOUS BISPHOSPHONATE USE FOLLOWING ANDROGEN DEPRIVATION THERAPY AMONG MEDICARE BENEFICIARIES WITH NON-METASTATIC PROSTATE CANCER Candice Yong, Eberechukwu Onukwugha, C. Daniel Mullins, Ilene Zuckerman, Arif Hussain, and Michael Naslund Candice YongCandice Yong More articles by this author , Eberechukwu OnukwughaEberechukwu Onukwugha More articles by this author , C. Daniel MullinsC. Daniel Mullins More articles by this author , Ilene ZuckermanIlene Zuckerman More articles by this author , Arif HussainArif Hussain More articles by this author , and Michael NaslundMichael Naslund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2487AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Androgen deprivation therapy (ADT) in prostate cancer (PC) is associated with significant bone loss and an increase in fracture risk. Current guidelines for men receiving ADT recommend screening for bone loss and initiating intravenous (IV) or oral bisphosphonate (BP) therapy in patients with fracture risk factors to attenuate cancer treatment-induced bone loss (CTIBL). Prior reports of BP use among elderly Medicare patients with PC have focused on IV BP use and hence may underestimate overall use of BP in this population. We estimated the prevalence of both oral and IV BP use following ADT initiation among elderly Medicare patients with non-metastatic PC. METHODS Using linked Surveillance, Epidemiology, and End Results (SEER) & Medicare data, we identified men aged 66+ with incident non-metastatic PC diagnosed during 2007-2009 (after the Medicare prescription drug benefit Part D was enacted in 2006). Patients were included if they received ADT within 6 months following diagnosis and had at least 6 months of Part D enrollment during follow-up. Claims data from 2006-2010 were used to characterize the prevalence of oral and IV BP use prior to and after ADT initiation. We also evaluated the prevalence of BP use in two subgroups of patients with baseline fracture risk factors: 1) diagnosis of osteoporosis, and 2) history of fracture in the one year prior to diagnosis. RESULTS The final sample included 7,545 non-metastatic PC patients who received ADT. The prevalence of any BP, oral BP, and IV BP use after ADT initiation was 8.2%, 5.2%, and 3.3% respectively. The median time to oral and IV BP use after ADT initiation was 140 days and 264 days, respectively. A small proportion (1.4%) of the sample had any BP use prior to ADT initiation and 91% of these men received oral BP. Among those with BP use prior to ADT, the median time between BP use and ADT initiation was 17 days (oral) and 20 days (IV). During the one year prior to PC diagnosis, 90 (1.2%) men had claims-based evidence of osteoporosis, of whom 51 (56.7%) received any BP post-ADT. At the same time, 290 (3.8%) men had a history of fracture at baseline, of whom 35 (12.1%) received any BP post-ADT. CONCLUSIONS Fewer than 1 in 10 men diagnosed with PC and initiating ADT received either oral or IV BP. Use of BP was relatively higher among men with baseline osteoporosis but lower than expected among men with a history of fracture. These results suggest that a significant gap remains in the prevention and treatment of CTIBL in this population of PC patients undergoing ADT. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e922 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Candice Yong More articles by this author Eberechukwu Onukwugha More articles by this author C. Daniel Mullins More articles by this author Ilene Zuckerman More articles by this author Arif Hussain More articles by this author Michael Naslund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Under CMS proposed rule, MTM coverage would expand greatly

CMS hopes to require Medicare Part D plans to expand the pool of patients eligible for Part D medication therapy management (MTM), according to the new proposed rule published Friday in the Federal Register. The proposed new criteria for Part D MTM eligibility would include patients having two or more chronic conditions, with at least one being a core chronic disease; taking any two or more covered Part D drugs; and having a minimum annual drug spend of $620. “CMS clearly indicated that they believe MTM is a quality service, that pharmacists’ services are very beneficial and cost effective, and that they fully intend for MTM utilization to expand significantly. It’s possible that something like 50% of Medicare beneficiaries will now be eligible for MTM, and it may well be more than that,” said Jillanne Schulte, JD, APhA Director of Regulatory Affairs. The agency’s loosening of the eligibility criteria for Part D MTM is a “great opportunity for pharmacists to show what they can do.” “One of the really great things about [the proposed rule] is it’s a floor. So if a plan wants to go above and beyond what’s in the rule, it can,” Schulte added. “It can extend MTM to any number of people, in theory.” APhA’s detailed analysis of CMS’s proposed rule on “Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs” is under way. The Association plans to comment by the deadline of March 7, 2014. “A lot of the rule is applicable more to Part D sponsors,” in terms of both fraud and abuse, and general organizational and contracting requirements, explained Schulte. But “a lot of these big changes are going to trickle down to pharmacists.” CMS also proposed changes related to the six protected drug categories or classes of clinical concern. When Part D started, CMS implemented a policy that all Part D plans must include on their formularies “all or substantially all” Part D drugs in six drug classes: antineoplastics, anticonvulsants, anti- retrovirals, antipsychotics, antidepres- sants, and immunosuppressants; the Affordable Care Act later made this policy the law, but allowed CMS to specify criteria for identifying protected classes through rulemaking, according to the agency’s January 6 fact sheet on the proposed rule. MORE ONLINE■An expanded version of this article is available at www.pharmacist.com/under-cms-proposed-rule-mtm-coverage-would-expand-greatly.■The CEO Blog perspective is available at www.pharmacist.com/CEOBlog/cms-proposes-rule-expanding-access-part-d-mtm. ■An expanded version of this article is available at www.pharmacist.com/under-cms-proposed-rule-mtm-coverage-would-expand-greatly.■The CEO Blog perspective is available at www.pharmacist.com/CEOBlog/cms-proposes-rule-expanding-access-part-d-mtm. Under two criteria proposed by CMS, the antineoplastic, anticonvulsant, and antiretroviral drug classes would remain protected classes of drugs, but as of 2015, Part D formularies would no longer be required to include all anti- depressants and immunosuppressants. “Antipsychotics will remain protected at least through 2015 while CMS evaluates additional considerations and the need for any other formulary exceptions,” according to the CMS fact sheet. CMS has “basically said that this is a cost issue,” said Schulte. The proposed rule also contains two big changes related to mail service that may result in more Part D beneficiaries walking into their local pharmacy. First, CMS would require mail-service pharmacies to fill prescriptions within 3 or 5 days and would not permit mail-service pharmacies to waive cost sharing for a Part D plan unless cost sharing is waived for all plan enrollees. “I don’t think the response from most Part D plans is going to be to waive more copayments. I think they’re going to cut the co- payment waivers off,” Schulte said. Second, CMS stated that new prescriptions and 30-day prescriptions should not be available through mail service. “If Part D plans comply, it’s going to be better for patients because when they do get a new prescription, they will have to see their pharmacist,” Schulte said. In addition to more patient counseling options, pharmacies may also see more foot traffic in stores.

Telephone provides unique entry into

In 2010, only about 8% of Medicare Part D enrollees who were eligible for a comprehensive medication review (CMR) received one, according to CMS. Cynthia Tudor, PhD, Director of the Medicare Drug Benefi t and C and D Data Group, predicted last March at the CMS 2012 Medicare Prescription Drug Benefi t Symposium that the number of eligible patients who receive the review will rise as more patients become aware of MTM and its value.

Policy Implications of Medicare Part D for Adults With Mental Illness: A Qualitative Exploration

The Medicare prescription drug benefit, introduced in January 2006, has had a substantial impact on the lives of adults disabled by mental illness. However, few studies have undertaken an exploration of the difference that this benefit has made to beneficiaries' access to medication. This study uses a qualitative approach to examine beneficiaries' experiences with the Medicare Part D benefit, and whether having Medicare prescription drug coverage is perceived as helpful. Twenty-six Medicare beneficiaries with mental illness were interviewed regarding their opinions of the Part D benefit, and the investigator found that most beneficiaries were highly satisfied with their prescription drug coverage. However, they would appreciate more information from the Medicare program about their benefits. In addition, beneficiaries were concerned about the possibility of increased future costs. Overall, however, these participants in the Medicare Part D program who had mental illness felt that their needs for psychotropic and other medications were met.

Medicare Part D Research and Policy Highlights, 2012: Impact and Insights

BackgroundIn the 6 years since the implementation of Medicare Part D in the United States, the program has been reported to improve quality, offer better beneficiary protections, and lower drug costs. ObjectiveThe purpose of this article was to highlight the latest key peer-reviewed research findings on Medicare Part D and major public policy initiatives for Part D for 2012. MethodsPubMed was searched for studies on Medicare Part D published in 2011 in biomedical/scientific, peer-reviewed, English-language journals. For the policy update, sources included the Federal Register, the Medicare Prescription Drug Benefit Manual, the 2012 Final Call Letter, and guidance from the Centers for Medicare and Medicaid Services. ResultsMedicare Part D has been associated with increased medication utilization, reduced out-of-pocket expenditures, and an overall decrease in cost-related non-adherence and nonpersistence. Its impact on reduction in non-drug utilization of health services has been more apparent after the transition year in 2006 and among subsets of Medicare beneficiaries. Recent policy changes promise to make Part D more user-friendly, simplify choice, and offer greater protection to beneficiaries. The coverage gap will phase out by 2020. Both the quality rating system for prescription drug plans and medication therapy management programs were enhanced. ConclusionsAlthough Part D was designed to improve drug benefits, improvements may be needed in plan selection and simplification, quality assessment (especially with regard to long-term impact and health outcomes), evidence-based improvements in medication therapy management, and disparities among priority subpopulations. Medicare Parts A, B, and D could be coordinated to offset costs by increasing medication expenses and decreasing expenses for nonprescription medical services, thereby improving the overall cost-effectiveness of the Medicare program.

Health Reform: A Political TragedyRemedy And Reaction: The Peculiar American Struggle Over Health Care Reform by Starr Paul New Haven (CT) : Yale University Press , 2011 324 pp.; $28.50

Health Reform: A Political TragedyRemedy And Reaction: The Peculiar American Struggle Over Health Care Reform by Starr Paul New Haven (CT) : Yale University Press , 2011 324 pp.; $28.50