Medicare Prescription Drug Program Research Articles

Did the Medicare Prescription Drug Program Lead to New Racial and Ethnic Disparities? Examining Long-term Changes in Prescription Drug Access among Minority Populations

ABSTRACT This study examined whether the Medicare Part D program was associated with racial/ethnic disparities in prescription drug access among elderly individuals who reported adequate access to physicians. Using a population-based survey of New Jersey residents, a difference-in-differences model estimated elderly blacks (OR = 3.20; p = .05) and Hispanics (OR = 4.29; p = .05) had higher odds than whites of reporting prescription access problems in the post, but not the pre-Part D period. The presence of prescription insurance did not lead to a significant decrease in access problems. Part D beneficiaries are required to make complicated decisions on cost-sharing and medication choices that require active involvement by physicians and pharmacists. Lack of guidance may critically impact minorities and economically vulnerable patients and cannot be addressed by extending coverage alone.

The Economic Burden of Out-of-Pocket Medical Expenditures Before and after Implementation of the Medicare Prescription Drug Program

Older Americans, although covered by Medicare, bear a large economic burden of medical expenses in the form of premiums for Medicare and supplemental plans, as well as the cost of uncovered or under-covered medical services. This study compares the patterns of this economic burden in 2010 with the baseline year of 2005. The period covered was marked by economic shocks, health care technology innovations and major Medicare reforms, including implementation of the prescription drug (Part D) program and changes in premium rules. Consequently, we present a description of the economic burden and do not attempt to make causal inferences. The definition of expenditures is limited to three components of out-of-pocket (OOP) medical spending: premiums, prescription drugs costs, and health services. While this definition is a limitation of the study, it also allows the researchers to focus on the costs most likely to be affected by improved access to prescription drugs and premium reforms.This paper found that:• Overall, the economic burden (expressed as a percent of income spent on OOP expenditures and premiums) averaged 18.5 percent of 2010 income, with top decile spending at 32 percent or more of their income going to health care. • A typical beneficiary spent 1.4 percentage points less of their income in 2010 than in 2005. When this burden is decomposed, we observed that the share of income spent for prescription drugs declined by 1.3 percentage points. This was the major component of the decline in this burden. The burden of premiums increased over the period, offsetting some of the gains from declining expenses for prescription drugs.• These gains were mostly observed at the high end of the burden distribution, i.e., those who were spending more than 20 percent of their income on health care. This group had lower incomes, on average, and were much less likely to possess employer-sponsored supplemental (or self-purchased) coverage. • Dual eligibles experienced a lower economic burden in 2010, even though their incomes were also significantly lower compared to the rest of the Medicare beneficiaries. Compared to other Medicare beneficiaries, they experienced relatively larger reductions in economic burden between 2005 and 2010.The policy implications of this paper are:• We observed some relief in the economic burden of prescription drug expenditures and overall health care, particularly for those who were most vulnerable to financial strains.• Our observations were consistent with the intended direction of policies implemented during the period. However, one can argue that the size of the gains was unremarkable when compared to the scope of the Part D reform. • Medicaid continued to fulfill its role as a safety net for those who are most vulnerable to financial strains. The relatively higher rate of decline for duals or low-income beneficiaries suggests that key components of the reform (premium- and cost-sharing assistance) are reaching the intended targets.• Affordability of high-cost drugs for the management of chronic conditions continues to be a major national health policy challenge. Medicare policy changes are likely to continue affecting out-of-pocket cost exposure to medications, particularly with the introduction and expansion in use of very high-priced specialty medications. Given the size and the unequal distribution of the economic burden of health care, we conclude that the economic burden needs to be a continuous concern when policy alternatives are discussed.

Does prescription drug coverage improve mental health? Evidence from Medicare Part D

The introduction of the Medicare Prescription Drug program (Part D) in 2006 resulted in a significant increase in access to coverage for older adults in the U.S. Several studies have documented the impact of this program on prescription drug utilization, expenditures and medication adherence among older adults. However, few studies have evaluated the extent to which these changes have affected the health of seniors. In this study we use data from the Health and Retirement Study to identify the impact of the Medicare Part D program on mental health. Using a difference-in-difference approach, we find that the program significantly reduced depressive symptoms among older adults. We explore the mechanisms through which this effect operates and evaluate heterogeneity in impact.

ACA in 2014: What patients need to know

Some pharmacies will have information on ACA for patients. “We will be bringing awareness to the ACA,” Lynn E. Connelly, BSPharm, owner of Medicine Mart Pharmacy in West Columbia, SC, told Pharmacy Today. He plans to learn of new information for his pharmacy and the patients from various pharmacy meetings throughout the state and the country. “In turn, I will share this information with the staff and the patients when possible,” Connelly explained. “It’s important that ACA-related information is widely distributed and readily available for patients who have questions,” said Stacie Maass, BSPharm, JD, APhA Senior Vice President of Government Affairs. This article, last in a Today series on the health care reform law, looks at what patients need to know for 2014. The latest on ACA The law’s cap on out-of-pocket costs of $6,350 for individuals will not be enforced for some employer-based health plans until 2015, as reported by Kaiser Health News in April and the New York Times on August 13. Consumers affected by the 1-year delay may be required to pay $6,350 for medical costs and an additional $6,350 for drug costs if their large employer has two benefi t providers for medical and for drugs. “If a drug plan does not currently have a limit on out-ofpocket costs, it will not have to impose healthcarereform

THE JANUARY EFFECT: MEDICATION REINITIATION AMONG MEDICARE PART D BENEFICIARIES

The Medicare prescription drug program (Part D) standard benefit includes deductible, initial coverage, coverage gap and catastrophic coverage phases. As beneficiaries enter each phase, their out-of-pocket medication costs change discontinuously. The benefit cycle restarts on 1 January of the next year. Taking advantage of variation in drug coverage, we study how individuals reinitiate discontinued medications in response to the non-linear price schedule. Because some beneficiaries who receive low-income subsidies (LIS) have zero or fixed small copayments throughout the year, we perform a difference-in-difference analysis by using the LIS group as a comparison. We find that individuals delay reinitiating important medications in December and are significantly more likely to reinitiate in January than in other months. Although we find some evidence that reinitiation is lower in the final months of the year, it is mostly driven by those who face higher prices due to the coverage gap. Our study suggests that individuals respond more to the current price of medications and do not anticipate future prices as well as theory would suggest.

ME2 Effect of Medicare Prescription Drug Program (Part D) on Medication Adherence for Dual Eligibles: Case of ACEIs and ARBs

ME2 Effect of Medicare Prescription Drug Program (Part D) on Medication Adherence for Dual Eligibles: Case of ACEIs and ARBs

UP-02.041 Initial Treatment of Incident Benign Prostatic Hyperplasia Cases in the United States, 2006

We have previously used U.S. Medicare Program claims data to describe evolving trends over the past decade in the surgical treatment of BPH/LUTS. In January 2006, the Medicare Program began coverage for elderly beneficiaries who chose to enroll in the Medicare Prescription Drug Program (Medicare Part D). Using these new drug data, we now describe the initial treatment choices made for incident cases of BPH/LUTS diagnosed in 2006.

Numeracy and Medicare Part D: The importance of choice and literacy for numbers in optimizing decision making for Medicare's prescription drug program.

Studies on decision making have come to challenge the idea that having more choice is necessarily better. The Medicare prescription drug program (Part D) has been designed to maximize choice for the consumer but has simultaneously created a highly complex decision task with dozens of options. In this study, in a sample of 121 adults, we examined the impact that increasing choice options has on decision-making abilities in older versus younger adults. Consistent with our hypotheses, we found that participants performed better with less choice versus more choice, and that older adults performed worse than younger adults across conditions. We further examined the role that numeracy may play in making these decisions and the role of more traditional cognitive variables such as working memory, executive functioning, intelligence, and education. Finally, we examined how personality style may interact with cognitive variables and age in decision making. Regression analysis revealed that numeracy is related to performance across the lifespan. When controlling for additional measures of cognitive ability, we found that although age was no longer associated with performance, numeracy remained significant. In terms of decision style, personality characteristics were not related to performance. Our results add to the mounting evidence for the critical role of numeracy in decision making across decision domains and across the lifespan.

Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy.

Evaluating the adequacy of Medicare prescription drug program (Part D) and its low-income subsidy (LIS) requires a comprehensive understanding of drug spending in relation to household resources. : To estimate out-of-pocket health care costs in the year before Part D, in context of total household spending, health status, and LIS eligibility. Nationally representative cross-sectional study. Two thousand two hundred thirty-one Medicare families in the 2005/2006 Health and Retirement Study. We assessed health care costs as a share of household resources remaining after spending on essential housing, food, personal care, and transportation. Burdensome health care costs were defined as exceeding 40% of nonessential resources. We used logistic regressions to assess the probability of incurring burdensome health expenditures, controlling for LIS eligibility. In the year before Part D, more than half of Medicare families [56.0%; 95% confidence interval (CI): 55.3-59.9] experienced burdensome health care costs. Families in poor health allocated a median of 68.1% [interquartile range (IQR): 35.1-82.9] of nonessential resources to health care (compared with 34.0% median; IQR 11.9-52.2 among families in excellent health, P < 0.011). Most (64%) out-of-pocket health care spending was allocated to health insurance premiums and medications. As many as 26% of Medicare families had burdensome health care costs but were not eligible for LIS assistance. Before Part D, burdensome health care expenditures were common in Medicare families. Our estimates of Part D and LIS benefits indicate a limited scope of relief.

Adverse Selection In The Medicare Prescription Drug Program

The Medicare Part D drug benefit created choices for beneficiaries among many prescription drug plans with varying levels of coverage. As a result, Medicare enrollees with high prescription drug costs have strong incentives to enroll in Part D, especially in plans with more comprehensive coverage. To measure this potential problem of "adverse selection," which could threaten plans' finances, we compared baseline characteristics among groups of beneficiaries with various drug coverage arrangements in 2006. We found some significant differences. For example, enrollees in stand-alone prescription drug plans, especially in plans offering benefits in the coverage gap, or "doughnut hole," had higher baseline drug costs and worse health than enrollees in Medicare Advantage prescription drug plans. Although risk-adjusted payments and other measures have been put in place to account for selection, these patterns could adversely affect future Medicare costs and should be watched carefully.

Older Adults Place Lower Value on Choice Relative to Young Adults

Choice is highly valued in modern society, from the supermarket to the hospital; however, it remains unknown whether older and younger adults place the same value on increased choice. The current investigation tested whether 53 older (M age = 75.44 years) versus 53 younger adults (M age = 19.58 years) placed lower value on increased choice by examining the monetary amounts they were willing to pay for increased prescription drug coverage options--important given the recently implemented Medicare prescription drug program. Results indicate that older adults placed lower value on increasing choice sets relative to younger adults, who placed progressively higher value on increasingly larger choice sets. These results are discussed regarding their implications for theory and policy.

Public/Private Partnerships for Prescription Drug Coverage: Policy Formulation and Outcomes in Quebec's Universal Drug Insurance Program, with Comparisons to the Medicare Prescription Drug Program in the United States

In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA.

Medicare Drug-Price Negotiation Faces Uncertain Future

Back to table of contents Previous article Next article Government NewsFull AccessMedicare Drug-Price Negotiation Faces Uncertain FutureMark MoranMark MoranSearch for more papers by this authorPublished Online:2 Feb 2007https://doi.org/10.1176/pn.42.3.0002The House of Representatives approved a bill last month allowing the federal government to negotiate with pharmaceutical companies over the price of drugs offered in the Medicare Part D prescription drug program.The bill, which was approved by a vote of 255-170, is expected to have a much harder time in the Senate. At press time, APA Director of Government Relations Nicholas Meyers told Psychiatric News, “It does not seem likely that the House bill will pass the Senate without revisions.”He noted that Senate Finance Committee Chair Max Baucus (D-Mont.) has“ expressed concerns about the legislation as it is now written and has called for some compromises.”The bill, the Medicare Prescription Drug Price Negotiation Act of 2007 (HR 4), states that the secretary of Health and Human Services (HHS) “shall negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged to prescription drug plan sponsors and Medicare Advantage organizations for covered Part D drugs for Part D–eligible individuals who are enrolled under a prescription drug plan or under [a Medicare Advantage] plan.”The inability of the government, representing millions of Medicare patients, to negotiate for lower prices has been a source of contention since passage of the Medicare prescription drug program in 2003. Opponents of the legislation claimed then that by prohibiting the government from negotiating over price, it paved the way for a bonanza for the pharmaceutical industry.APA has not taken a position on the bill, though in the run-up to its passage, it continued to advocate for access to psychiatric medications, whatever the outcome of the House vote. In a January 12 letter to House Speaker Nancy Pelosi (D-Calif.) and other House leaders, APA Medical Director James H. Scully Jr., M.D., urged House members to ensure that the legislation“ does not carry the unintended consequence of limiting beneficiary access to important medications.”Meyers told Psychiatric News that the drug-pricing discussions are part of a larger debate about access to care.“Access to the full range of medications psychiatrists use to treat their patients is also critical, which is why we have worked hard with the National Alliance on Mental Illness, Mental Health America, and others to ensure that the Part D implementation did not result in potentially catastrophic interruptions in, or abrupt switching of, psychotropic medications,” he said.He added that Scully's letter was intended to remind House leaders that the government has thus far protected psychiatric drugs in the Medicare prescription drug program and that enactment of drug-negotiation legislation does not change the need for continued protection.“We also recognize that the best medications in the world aren't going to work if patients can't afford them, which is why we joined with other medical specialties and patient groups in actively supporting the Partnership for Prescription Assistance,” Meyers said. “The PPA doesn't solve the drug-pricing debate, but it does bring immediate help to patients who have trouble paying for their medicine.”The Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient-assistance programs, including more than 150 programs offered by pharmaceutical companies. It is supported by member companies in Pharmaceutical Research and Manufacturers of America (PHRMA) and medical and health care advocacy organizations, including APA.Predictably, the Bush administration and the pharmaceutical industry did not respond favorably to news of the bill's passage.HHS Secretary Mike Leavitt noted in a statement that the Congressional Budget Office had determined that the legislation would not result in lower drug prices.“I am disappointed that a majority of House members discounted the overwhelming success of the Medicare Part D program over the last year and voted to pass HR 4,” Leavitt said. “Despite statements from the nonpartisan Congressional Budget Office and the independent Centers for Medicare and Medicaid Services' actuaries that this legislation would not result in savings, this legislation was hastily adopted without hearings in the House. We hope that the Senate will reflect on the evidence and resist the temptation to undermine a program that is working well for millions of people with Medicare.”The Pharmaceutical Care Management Association, in a statement released after the House action, said passage of the bill “would take the Medicare drug benefit in the wrong direction and potentially shift additional costs to private and public payers, including Medicaid and the Veterans Administration.”The text of HR 4 can be accessed at<http://thomas.loc.gov/cgi-bin/Thomas> by searching on the bill number. Information about the Partnership for Prescription Assistance is posted at<www.pparx.org/Intro.php>.▪ ISSUES NewArchived

Pharmacy Profile The Many Facets of Joseph Gruber: 2006-2007 ASCP President

Joseph Gruber, RPh, CGP, FASCP, incoming president of ASCP, has devoted his career to proving that pharmacists provide critical clinical information--not just dispense medications. His goal as president is to focus on implementation of the new Medicare prescription drug program, Medicare Part D, which includes a provision for payment for medication therapy management services.

Most Americans Don't See Part D in Their Future

Most Americans Don't See Part D in Their Future

Medicaid Patients Suffer Most From Part D Transition Problems

Medicaid Patients Suffer Most From Part D Transition Problems

Gazing into the Crystal Ball: Health Care, Health Policy, and Rehabilitation for Spinal Cord Injury

The US Congress faces a host of health issues that demand immediate attention. Many of these issues are of considerable importance to those persons with spinal cord injury (SCI), including the rising cost of health care and health insurance, the current budget shortfalls facing state governments, and the need for a Medicare prescription drug program. Persons with disabilities are becoming increasingly dependent on public forms of insurance, like Medicare and Medicaid, and are bearing a disproportionate share of service curtailment. Other issues relevant to persons with disabilities and health care providers are prospective payment reimbursement implementation for rehabilitation, the reauthorization of the Rehabilitation Act, and the New Freedom Initiative. Considering the political climate and the importance of such issues, the need for advocacy among professionals and consumers is greater than ever.