The Effects of Medicare Part D on Health Outcomes of Newly Covered Medicare Beneficiaries

Abstract Evidence supports the potential for e-prescribing to reduce the incidence of adverse drug events (ADEs) in hospital-based studies, but studies in the ambulatory setting have not used occurrence of ADE as their outcome. Using the “prescription origin code” in 2011 Medicare Part D prescription drug events files, the authors investigate whether physicians who meet the meaningful use stage 2 threshold for e-prescribing (≥50% of prescriptions e-prescribed) have lower rates of ADEs among their diabetic patients. Risk of any patient with diabetes in the provider’s panel having an ADE from anti-diabetic medications was modeled adjusted for prescriber and patient panel characteristics. Physician e-prescribing to Medicare beneficiaries was associated with reduced risk of ADEs among their diabetes patients (Odds Ratio: 0.95; 95% CI, 0.94-0.96), as were several prescriber and panel characteristics. However, these physicians treated fewer patients from disadvantaged populations.

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Impact of Medicare Part D on Prescription Use, Health Care Expenditures, and Health Services Utilization: National Estimates for Medicare Beneficiaries, 2002 to 2009

Value in Health ◽

10.1016/j.jval.2013.08.815 ◽

2013 ◽

Vol 16 (7) ◽

pp. A464

Author(s):

L.I. Cheng ◽

K.L. Rascati

Keyword(s):

Health Care ◽

Health Services ◽

Health Services Utilization ◽

Medicare Part D ◽

Health Care Expenditures ◽

Medicare Part ◽

Medicare Beneficiaries ◽

Part D ◽

Services Utilization ◽

National Estimates

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PIN73 - ECONOMIC BURDEN OF HIV/AIDS AMONG ELDERLY MEDICARE BENEFICIARIES POST MEDICARE PART D

Value in Health ◽

10.1016/j.jval.2018.09.1392 ◽

2018 ◽

Vol 21 ◽

pp. S233

Author(s):

E.E. Chinaeke ◽

K. Lu ◽

M.S. Li ◽

J. Wu ◽

G. Reeder

Keyword(s):

Economic Burden ◽

Medicare Part D ◽

Medicare Part ◽

Medicare Beneficiaries ◽

Part D ◽

Hiv Aids

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Community Pharmacy Medicare Part D Consultations: Plan-Switching Decisions and Chronic Medication Adherence

Journal of Pharmacy Practice ◽

10.1177/0897190020903852 ◽

2020 ◽

pp. 089719002090385

Author(s):

Logan T. Murry ◽

Rylan C. Murry ◽

Huiwen Deng ◽

Brahmendra Viyyuri ◽

Brandon L. Gerleman ◽

...

Keyword(s):

Medication Adherence ◽

Service Use ◽

Medicare Part D ◽

Medicare Part ◽

Service Users ◽

Significant Positive Effect ◽

Medicare Beneficiaries ◽

Part D ◽

Chronic Medication ◽

Positive Effect

Objectives: (1)To compare Part D plan switching for users and nonusers of a pharmacy-led Medicare Part D consultation service and (2) to evaluate the effect of service use on chronic medication adherence. Methods: This was a longitudinal study, occurring in one independently owned community pharmacy in Iowa. Medicare Part D beneficiaries who used the service were compared to nonusers. Dispensing data were used to compare planswitching and the effect of service use on chronic medication adherence between service users and nonusers. Proportion of days covered (PDC) was used to evaluate medication adherence. Results: In the 2017 and 2018 plan year, 79 and 138 Medicare beneficiaries used the service, respectively. These individuals were compared to 849 Medicare beneficiaries and a random sample of 101 beneficiaries in respective years. The respective switching rates for service users in 2018 and 2019 plan year were 43% and 15.9%, compared to 4% switching rates in both years for nonusers. Using the Medicare Part D consultation yielded a statistically significant positive effect on switching in both plan years ( P values < .05) and a statistically significant positive effect on PDC between years ( P value <.05). Conclusion: The use of a pharmacist-led Medicare Part D consultation resulted in increased plan switching and improved chronic medication adherence.

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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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Impact of Medicare Part D on out-of-pocket drug costs and utilization for patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.275 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 275-275

Author(s):

Sheetal Mehta Kircher ◽

Michael Johansen ◽

Matthew M. Davis

Keyword(s):

Prescription Drug ◽

Prescription Drugs ◽

Medicare Part D ◽

Drug Costs ◽

Medicare Part ◽

Prescription Drug Coverage ◽

Medicare Beneficiaries ◽

Part D ◽

Patients With Cancer ◽

Per Capita

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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Association Between Pharmacy Benefit Restrictions and Disease-Modifying Therapy Use in the Medicare Part D Program

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001118 ◽

2021 ◽

pp. 10.1212/CPJ.0000000000001118

Author(s):

Daniel M Hartung ◽

Kirbee A Johnston ◽

Jessina C McGregor ◽

Dennis N Bourdette

Keyword(s):

Medication Possession Ratio ◽

Medicare Part D ◽

Medicare Part ◽

Medicare Beneficiaries ◽

Part D ◽

Patient Demographics ◽

Disease Modifying Therapy ◽

Outpatient Visits ◽

Disease Modifying ◽

Step Therapy

AbstractObjective:To determine the association between Medicare Part D Plan disease-modifying therapy (DMT) restrictiveness and adherence and outcomes among people with multiple sclerosis (MS)Methods:We used Medicare claims data from 2010 to 2014 to identify individuals with a full year enrollment (Part A, B, D), an MS diagnosis, and one or more self-administered DMT prescription. Plans were considered restrictive if all available DMTs required a prior authorization or step therapy restriction; otherwise they were considered permissive. We compared DMT adherence, defined as a medication possession ratio (MPR) >=80%, MS-related emergency department (ED) or inpatient admissions, and outpatient visits by Part D plan restrictiveness. We used multivariate regression models to control for patient demographics and comorbidities.Results:There were 37,713 Medicare beneficiaries with MS who were enrolled in either restrictive (n=29,901) or permissive (n=7812) Part D plans during the study period. Patients enrolled in restrictive plans were older (60 versus 58 years; p<.001), more likely to live in the south (38% vs 23%; p<.001), eligible through disability (67% vs 60%; p<.001), and more likely to have several chronic comorbid conditions. Patients enrolled in restrictive plans were less likely to be adherent to their DMT (54% vs 57%; p<0.001; adjusted odds ratio [aOR] 0.92, 95% confidence interval [CI] 0.88 to 0.98] and had a higher rate of MS-related outpatient visits (1.7 vs 1.4 per year; p<.001; adjust rate ratio (aRR) 1.27, 95% CI 1.23 to 1.31).Conclusions:Medicare beneficiaries with MS enrolled in restrictive Part D plans were less adherent to their DMT and had higher rates of MS-related outpatient visits.

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