Medicare Beneficiaries' Knowledge of Part D Prescription Drug Program Benefits and Responses to Drug Costs

275 Background: Medicare Part D was designed to reduce out of pocket (OOP) costs for Medicare beneficiaries, but the extent to which this occurred for patients with cancer has not been measured. The aim of this study is to quantify the impact of Part D eligibility on OOP cost for prescription drugs and utilization for cancer patients. Methods: Differences-in-differences analyses were used to estimate the effects of Medicare Part D eligibility on OOP drug costs, by comparing 4 year periods before and after Part D implementation. Analyses were based on data from the publicly available Medical Expenditure Panel Survey, a nationally representative, all-payer sample of the United States non-institutionalized civilian population. Our analysis compared per-capita OOP burden between Medicare beneficiaries (age 65+) with cancer to near-elderly individuals age 55-64 years old with cancer. Results: 2,077 near-elderly individuals with cancer and 4,723 individuals with Medicare and cancer were included (total n=6,800), representing over 85 million people. Prescription drug coverage increased among individuals with Medicare from before Part D (39%) to after (65%); in contrast, prescription drug coverage among the near-elderly remained stable before vs. after Part D (82.4% vs. 81.4%). The mean per-capita OOP cost for Medicare beneficiaries with cancer before Part D was $1,111 (SE ±45) and decreased to $694 (±35) after implementation of Medicare Part D—a decline of 37%. Compared with changes in OOP drug costs for non-elderly patients with cancer over the same period, implementation of Medicare Part D was associated with a further reduction of $286 per person. OOP costs for cancer-associated drugs (i.e., antineoplastic, pain medications, anti-emetics) accounted for 6.5-11.1% of the total OOP cost with no significant trends between 2002-2010. Conclusions: The implementation of Medicare D has significantly reduced OOP prescription drug costs for seniors with cancer, beyond trends observed for younger patients. Considering prescription drugs for all medical conditions, cancer associated drugs compose a minority of the cost, highlighting that cancer patients have many comorbid conditions contributing to overall costs.

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People with Colorectal Cancer in SEER-Medicare: Part D Uptake, Costs, and Outcomes

10.3768/rtipress.2020.rr.0037.2005 ◽

2020 ◽

Author(s):

Lisa M. Lines ◽

Florence K. L. Tangka ◽

Sonja Hoover ◽

Sujha Subramanian

Keyword(s):

Colorectal Cancer ◽

Prescription Drug ◽

Drug Costs ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Limited Information ◽

Part D ◽

Complete Part ◽

Significant Difference ◽

Prescription Drug Costs

Limited information exists about enrollment in Part D prescription coverage by Medicare beneficiaries with cancer. Part D coverage may increase access to medicines. This study evaluated patterns of Part D uptake and costs and assessed the effects of coverage on hospitalizations and emergency department (ED) use among people with colorectal cancer (CRC). We analyzed Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data on fee-for-service (FFS) Medicare beneficiaries with at least 36 months of follow-up who were diagnosed with CRC at any point from January 2007 through December 2010, and a matched cohort of beneficiaries without cancer. Dual (Medicare/Medicaid) enrollees were excluded because they are automatically enrolled in Part D. Among beneficiaries with CRC (n=12,774), 39 percent had complete Part D coverage, defined as coverage in the diagnosis year and 2 subsequent years; the rate was 38 percent in the matched comparison cohort (P=.119). Among those with complete Part D coverage, there was no significant difference in annual prescription drug costs between people with CRC ($3,157, 95% confidence interval [CI]: $3,098–$3,216) and without ($3,113, 95% CI: $3,054–$3,172). Among people with CRC, odds of ED use ranged from unchanged to marginally higher for those with no or partial Part D coverage, (adjusted odds ratio: 1.09, 95% CI: 1.00–1.18), compared with those with complete Part D coverage. Lack of continuous Part D coverage was associated with more ED use among Medicare FFS beneficiaries with CRC in 2007–2013. Among people with Part D coverage, prescription drug costs varied little between those with CRC and matched beneficiaries without cancer.

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Comparative Usability Study of a Newly Created Patient-Centered Tool and Medicare.gov Plan Finder to Help Medicare Beneficiaries Choose Prescription Drug Plans

Journal of Patient Experience ◽

10.1177/2374373518778343 ◽

2018 ◽

Vol 6 (1) ◽

pp. 81-86 ◽

Cited By ~ 1

Author(s):

Cheryl D Stults ◽

Sayeh Fattahi ◽

Amy Meehan ◽

M Kate Bundorf ◽

Albert S Chan ◽

...

Keyword(s):

Prescription Drug ◽

Selection Process ◽

Ease Of Use ◽

Usability Study ◽

Medicare Beneficiaries ◽

Patient Centered ◽

Part D ◽

Drug Plan ◽

Plan Selection ◽

Expert Recommendations

Introduction: In response to reported difficulties in selecting a Medicare Part D prescription drug plan, we designed a patient-centered online Part D plan selection tool (CHOICE1.0) to simplify the selection process and to provide personalized, expert recommendations. Methods: This ethnographic comparative usability study observed 44 patients using the first version of the tool during Medicare 2016 Open Enrollment. Participants were observed as they chose their drug plan using Medicare.gov and 1 of 3 versions of CHOICE1.0 that varied in amount of expert guidance. Descriptive statistics were used to analyze exit survey data. The observations were video-recorded, and field notes were analyzed thematically. Results: Participants were significantly more satisfied with CHOICE1.0 for choosing a plan, understanding information, and ease of use compared to Medicare.gov . Those using expert versions of CHOICE1.0 were more likely to indicate their intention to switch plans than those using Medicare.gov , though they wanted to know the source and content. Conclusion: The more patient-centered prescription drug choice tool improved user experience and enabled users to choose plans more consistent with expert recommendations.

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Promoting Access and Reducing Expected Out-of-Pocket Prescription Drug Costs for Vulnerable Medicare Beneficiaries

Medical Care ◽

10.1097/mlr.0b013e318202a9f2 ◽

2011 ◽

Vol 49 (4) ◽

pp. 343-347 ◽

Cited By ~ 13

Author(s):

Timothy W. Cutler ◽

Marilyn R. Stebbins ◽

Amanda R. Smith ◽

Rajul A. Patel ◽

Helene L. Lipton

Keyword(s):

Prescription Drug ◽

Drug Costs ◽

Medicare Beneficiaries ◽

Prescription Drug Costs

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The New Medicare Part D Prescription Drug Benefit: An Estimation of Its Effect on Prescription Drug Costs in a Medicare Population with Atrial Fibrillation

Yearbook of Cardiology ◽

10.1016/s0145-4145(08)06013-9 ◽

2008 ◽

Vol 2008 ◽

pp. 498-499

Author(s):

A.L. Waldo

Keyword(s):

Atrial Fibrillation ◽

Prescription Drug ◽

Medicare Part D ◽

Drug Costs ◽

Medicare Part ◽

Drug Benefit ◽

Part D ◽

Prescription Drug Benefit ◽

Medicare Population ◽

Prescription Drug Costs

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The Impact of Medicare Part D on the Proportion of Out-of-Pocket Prescription Drug Costs Among Older Adults With Diabetes

Diabetes Care ◽

10.2337/dc16-0902 ◽

2016 ◽

Vol 40 (4) ◽

pp. 502-508 ◽

Cited By ~ 2

Author(s):

Yoon Jeong Choi ◽

Haomiao Jia ◽

Tal Gross ◽

Katie Weinger ◽

Patricia W. Stone ◽

...

Keyword(s):

Older Adults ◽

Prescription Drug ◽

Medicare Part D ◽

Drug Costs ◽

Medicare Part ◽

Part D ◽

The Impact ◽

Prescription Drug Costs

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Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958017734032 ◽

2017 ◽

Vol 54 ◽

pp. 004695801773403

Author(s):

Katherine A. Desmond ◽

Thomas H. Rice ◽

Arleen A. Leibowitz

Keyword(s):

Prescription Drug ◽

Low Income ◽

Drug Regimen ◽

Medicare Beneficiaries ◽

Part D ◽

Total Spending ◽

Prescription Drug Plans ◽

The Difference ◽

Living With Hiv ◽

Hiv Aids

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

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Impact of Medicare Part D on out-of-pocket pharmaceutical costs for patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6517 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6517-6517

Author(s):

Sheetal Mehta Kircher ◽

Michael Johansen ◽

Caroline Richardson ◽

Matthew M Davis

Keyword(s):

Prescription Drug ◽

Medicare Part D ◽

Medicare Part ◽

Prescription Drug Coverage ◽

Medicare Beneficiaries ◽

Part D ◽

Patients With Cancer ◽

Per Capita ◽

Nationally Representative ◽

Pharmaceutical Costs

6517 Background: As federal policy, Medicare Part D was designed to reduce OOP costs for Medicare beneficiaries, but the extent to which this occurred for patients with cancer has not been measured. The aim of this study is to quantify the impact of Part D eligibility on out-of-pocket (OOP) cost for prescription drugs for cancer patients. Methods: Differences-in-differences analyses were used to estimate the effects of Medicare Part D eligibility on OOP pharmaceutical costs, by comparing 4-year periods before and after Part D implementation. Analyses were based on data from the publicly available Medical Expenditure Panel Survey, a nationally representative, all-payer sample of the United States non-institutionalized civilian population. Our analysis compared per-capita OOP burden between Medicare beneficiaries (age 65+) with cancer to near-elderly patients age 55-64 years old with cancer. Statistical weights provided with the dataset were used to generate nationally representative estimates. Results: Overall, 2,147 near-elderly individuals with cancer and 5,296 individuals with Medicare and cancer were included in the analysis (total n=7,443), representing over 88 million people with cancer in 8 years of study. As expected, prescription drug coverage more than doubled among individuals with Medicare from before Part D (34.4%) to after (77.8%); in contrast, prescription drug coverage among the near-elderly remained stable before vs. after Part D (72.0% vs. 71.1%). The mean per-capita OOP cost for Medicare beneficiaries with cancer before Part D was $935 (SE ±30) and decreased to $616 (±25) after implementation of Medicare Part D—a decline of 34%. Compared with changes in OOP pharmaceutical costs for non-elderly patients with cancer over the same period, implementation of Medicare Part D was associated with a further reduction of $159 (±73) per person with cancer. Conclusions: The implementation of Medicare D has significantly reduced OOP prescription drug costs for seniors with cancer, beyond trends observed for younger patients. Further analyses will examine OOP cost patterns for patients with cancer with specific sociodemographic and clinical characteristics.

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