PDB68 AN ASSESSMENT OF THE IMPACT OF THE COVERAGE GAP UPON MEDICARE PART D BENEFICIARIES UTILIZING INSULIN

Purpose The high cost of oncology drugs threatens the affordability of cancer care. Previous research identified drivers of price growth of targeted oral anticancer medications (TOAMs) in private insurance plans and projected the impact of closing the coverage gap in Medicare Part D in 2020. This study examined trends in TOAM prices and patient out-of-pocket (OOP) payments in Medicare Part D and estimated the actual effects on patient OOP payments of partial filling of the coverage gap by 2012. Methods Using SEER linked to Medicare Part D, 2007 to 2012, we identified patients who take TOAMs via National Drug Codes in Part D claims. We calculated total drug costs (prices) and OOP payments per patient per month and compared their rates of inflation with general health care prices. Results The study cohort included 42,111 patients who received TOAMs between 2007 and 2012. Although the general prescription drug consumer price index grew at 3% per year over 2007 to 2012, mean TOAM prices increased by nearly 12% per year, reaching $7,719 per patient per month in 2012. Prices increased over time for newly and previously launched TOAMs. Mean patient OOP payments dropped by 4% per year over the study period, with a 40% drop among patients with a high financial burden in 2011, when the coverage gap began to close. Conclusion Rising TOAM prices threaten the financial relief patients have begun to experience under closure of the coverage gap in Medicare Part D. Policymakers should explore methods of harnessing the surge of novel TOAMs to increase price competition for Medicare beneficiaries.

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Potential Impact of Pharmacist Interventions to Reduce Cost for Medicare Part D Beneficiaries

Journal of Pharmacy Practice ◽

10.1177/0897190012465983 ◽

2012 ◽

Vol 26 (3) ◽

pp. 248-252 ◽

Cited By ~ 4

Author(s):

Erin E. Thatcher ◽

Elizabeth M. VanWert ◽

Steven R. Erickson

Keyword(s):

General Medicine ◽

Medicare Part D ◽

Medicare Part ◽

Medication Cost ◽

Primary Analysis ◽

Part D ◽

Medicine Clinic ◽

Coverage Gap ◽

Pharmacist Interventions ◽

The Impact

The objective was to determine the impact of simulated pharmacist interventions on out-of-pocket cost, time to coverage gap, and cost per patient to the Medicare Part D program using actual patient cases from an adult general medicine clinic. Medication profiles of 100 randomly selected Medicare-eligible patients from a university-affiliated general internal medicine clinic were reviewed by a pharmacist to identify opportunities to cost-maximize the patients’ therapies based on the plan. An online Part-D calculator, Aetna Medicare Rx Essentials, was used as the standard plan to determine medication cost and time to gap. The primary analysis was comparison of the patients’ pre-review and post-review out-of-pocket cost, time to coverage gap, and cost to Medicare. A total of 65 patients had at least 1 simulated pharmacist cost intervention. The most common intervention was substituting for a less costly generic, followed by substituting a generic for a brand name. Projected patient cost savings was $476 per year. The average time to coverage gap was increased by 0.7 ±1.2 months. This study illustrates that the pharmacists may be able to reduce cost to some patients as well as to the Medicare Part D program.

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Five‐year impact of Medicare Part D coverage gap reform on drug expenditures and utilization

Health Services Research ◽

10.1111/1475-6773.13660 ◽

2021 ◽

Author(s):

Joohyun Park ◽

Kevin A. Look

Keyword(s):

Medicare Part D ◽

Medicare Part ◽

Part D ◽

Coverage Gap ◽

Drug Expenditures

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The effect of Medicare Part D on prescription drug composition and demand

Journal of Economic Studies ◽

10.1108/jes-08-2013-0109 ◽

2015 ◽

Vol 42 (2) ◽

pp. 170-185 ◽

Cited By ~ 4

Author(s):

David Zimmer

Keyword(s):

Prescription Drug ◽

Medicare Part D ◽

Medicare Part ◽

Part D ◽

Content Type ◽

The Us ◽

Upper Respiratory ◽

Nationally Representative ◽

The Impact ◽

Shed Light

Purpose – The US Medicare Modernization Act of 2003 introduced optional prescription drug coverage, beginning in 2006, widely known as Medicare Part D. This paper uses up-to-date nationally representative survey data to investigate the impact of Part D not only on drug spending and consumption, but also on the composition of drug consumption. The paper aims to discuss these issues. Design/methodology/approach – Specifically, the paper investigates whether Part D impacted the number of therapeutic classes for which drugs were prescribed, and also whether Part D lead to increased usage of drugs for specific medical conditions that typically receive drug-intensive therapies. Findings – In addition to confirming findings from previous studies, this paper shows that Part D increased the number of therapeutic classes to which seniors receive drugs by approximately four classes. Part D also lead to increased usage of drugs used to treat upper respiratory disease, hypertension, and diabetes. Originality/value – While mostly concurring with previous studies on the spending impacts of Part D, this paper is the first to shed light on other impacts of Part D, specifically with respect to its impact on therapeutic classes for which drugs are prescribed.

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PNL18 THE IMPACT OF MEDICARE PART D ON ECONOMIC BARRIERS TO PRESCRIPTION MEDICATIONS AMONG BENEFICIARIES WITH MULTIPLE SCLEROSIS

Value in Health ◽

10.1016/s1098-3015(10)62832-x ◽

2005 ◽

Vol 8 (3) ◽

pp. 319-320

Author(s):

JJ Lundy ◽

BM Craig

Keyword(s):

Multiple Sclerosis ◽

Medicare Part D ◽

Medicare Part ◽

Prescription Medications ◽

Part D ◽

Economic Barriers ◽

The Impact

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The impact of consumer inattention on insurer pricing in the Medicare Part D program

The RAND Journal of Economics ◽

10.1111/1756-2171.12207 ◽

2017 ◽

Vol 48 (4) ◽

pp. 877-905 ◽

Cited By ~ 27

Author(s):

Kate Ho ◽

Joseph Hogan ◽

Fiona Scott Morton

Keyword(s):

Medicare Part D ◽

Medicare Part ◽

Part D ◽

The Impact

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Differential Effects by Mental Health Status of Filling the Medicare Part D Coverage Gap

Medical Care ◽

10.1097/mlr.0000000000001668 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Judith Liu ◽

Yuting Zhang ◽

Cameron M. Kaplan

Keyword(s):

Mental Health ◽

Health Status ◽

Medicare Part D ◽

Mental Health Status ◽

Medicare Part ◽

Part D ◽

Differential Effects ◽

Coverage Gap

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The Medicare Part D Coverage Gap, Prescription Use, and Expenditures

Medical Care Research and Review ◽

10.1177/1077558718806437 ◽

2018 ◽

Vol 77 (5) ◽

pp. 442-450 ◽

Cited By ~ 1

Author(s):

Aig Unuigbe

Keyword(s):

Affordable Care Act ◽

Financial Risk ◽

Medicare Part D ◽

Medicare Part ◽

General Increase ◽

Part D ◽

Coverage Gap ◽

Heterogeneous Effects ◽

Drug Expenditures ◽

Donut Hole

The Affordable Care Act has put in place policies to gradually close the Medicare Part D coverage gap (donut hole). I examine the effect of this gradual closure on total and out-of-pocket prescription drug expenditures, as well as the number of prescriptions filled. The analysis shows a general increase in prescription use. There are also heterogeneous effects, with higher total expenditure groups seeing a decrease in their out-of-pocket prescription expenditures. This suggests that closure of the “donut hole” has led to an increase in prescription use that was previously curtailed and had an impact on the financial risk faced by Medicare recipients. This has implications for trends in prescription use and Medicare expenditures in the future, as the coverage gap is closed further.

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