scholarly journals Effects of Medicare Drug Subsidies on Adherence for Diabetics: Evidence From a Regression Discontinuity Design

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 280-280
Author(s):  
Alexandra Glynn ◽  
Inmaculada Hernandez ◽  
Eric Roberts
Keyword(s):  
Medication Adherence ◽  
Low Income ◽  
Regression Discontinuity ◽  
Drug Costs ◽  
Financial Strain ◽  
Medicare Beneficiaries ◽  
Poverty Level ◽  
Improve Medication Adherence ◽  
Part D ◽  
Out Of Pocket Costs

Abstract Out-of-pocket prescription drug costs are rapidly rising, particularly for insulin, which is a life-saving drug used by 3.1 million diabetics on Medicare. High out-of-pocket costs place an accentuated financial strain on older adults with diabetes, many of whom have low incomes, and may impede medication adherence, leading to poor health outcomes. The Medicare Part D Low-Income Subsidy (LIS) program limits drug co-pays to under $8.50 per prescription and caps out-of-pocket drug costs for lowest-income recipients (<135% Federal Poverty Level, FPL), resulting in pronounced differences in out-of-pocket costs for those with marginally different incomes. Using detailed income data from the Health and Retirement Study linked to Medicare claims (2008-2016), we employed a regression discontinuity (RD) design to isolate the effects of differences in out-of-pocket costs at eligibility thresholds for the LIS. Diabetic beneficiaries whose income exceeded the LIS eligibility threshold had lower Part D spending (-$945/year, p=0.03, n=2,367) and adherence to oral antidiabetic drugs (-8%, p=0.02). We conducted secondary analyses at the eligibility threshold for Medicaid, as individuals whose income exceeds the eligibility limit for Medicaid (100% of FPL in most states) are significantly less likely to receive the LIS. Above the Medicaid eligibility threshold (n=2,295), annual spending on insulin was $395 lower (p=0.002) and proportion of insulin use was 6% lower (p=0.04). These results suggest low-income Medicare beneficiaries who are not shielded from out-of-pocket costs via the LIS are particularly sensitive to drug costs. Policy proposals to limit out-of-pocket costs could improve medication adherence to high-cost drugs for vulnerable beneficiaries.

scholarly journals Subsidies for Oral Chemotherapy and Use of Immunomodulatory Drugs Among Medicare Beneficiaries With Myeloma

2017 ◽  
Vol 35 (29) ◽  
pp. 3306-3314 ◽  
Author(s):  
Adam J. Olszewski ◽  
Stacie B. Dusetzina ◽  
Charles B. Eaton ◽  
Amy J. Davidoff ◽  
Amal N. Trivedi
Keyword(s):  
Low Income ◽  
Age Groups ◽  
Emergency Department Visits ◽  
First Year ◽  
Adjusted Relative Risk ◽  
Immunomodulatory Drugs ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Medicare Costs ◽  
Out Of Pocket Costs

Purpose The low-income subsidy (LIS) substantially lowers out-of-pocket costs for qualifying Medicare Part D beneficiaries who receive orally administered chemotherapy. We examined the association of LIS with the use of novel oral immunomodulatory drugs (IMiDs; lenalidomide and thalidomide) among beneficiaries with myeloma, who can receive either orally administered or parenteral (bortezomib-based) therapy. Methods Using SEER-Medicare data, we identified Part D beneficiaries diagnosed with myeloma in 2007 to 2011. In multivariable models adjusted for sociodemographic and clinical characteristics, we analyzed associations between the LIS and use of IMiD-based therapy, delays between IMiD refills, and select health outcomes during the first year of therapy. Results Among 3,038 beneficiaries, 41% received first-line IMiDs. Median out-of-pocket cost for the first IMiD prescription was $3,178 for LIS nonrecipients and $3 for LIS recipients, whereas the respective median costs for the first year of therapy were $5,623 and $6, respectively. Receipt of the LIS was associated with a 32% higher (95% CI, 16% to 47%) probability of receiving IMiDs among beneficiaries age 75 to 84 years and a significantly lower risk of delays between refills in all age groups (adjusted relative risk, 0.54; 95% CI, 0.32 to 0.92). Duration of therapy did not significantly differ between LIS recipients and nonrecipients (median, 7.6 months). Patients treated with IMiDs had significantly fewer emergency department visits and hospitalizations compared with patients receiving bortezomib (without IMiDs), but 1-year overall survival and cumulative Medicare costs were similar. Conclusion Medicare beneficiaries with myeloma who do not receive LISs face a substantial financial barrier to accessing orally administered anticancer therapy, warranting urgent attention from policymakers. Limiting out-of-pocket costs for expensive anticancer drugs like the IMiDs may improve access to oral therapy for patients with myeloma.

scholarly journals PNS105 ASSOCIATION OF LOW-INCOME SUBSIDY/DUAL ELIGIBILITY AND DISABILITY WITH HIGH-RISK MEDICATION USE AMONG PART D MEDICARE BENEFICIARIES

2020 ◽  
Vol 23 ◽  
pp. S303
Author(s):  
C. Chinthammit ◽  
S. Bhattacharjee ◽  
M. Slack ◽  
W. Lo-Ciganic ◽  
J.P. Bentley ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
Medication Use ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Dual Eligibility

scholarly journals Hypertensive Urgency in Tanzanian Adults: A 1-Year Prospective Study

2020 ◽  
Author(s):  
Karl G Reis ◽  
Raymond Wilson ◽  
Fredrick Kalokola ◽  
Bahati Wajanga ◽  
Myung-Hee Lee ◽  
...  
Keyword(s):  
Medication Adherence ◽  
High Risk ◽  
Prospective Study ◽  
Low Income ◽  
Hypertensive Crisis ◽  
The United States ◽  
Low Income Countries ◽  
Improve Medication Adherence ◽  
Hypertensive Urgency ◽  
Poor Outcomes

Abstract BACKGROUND Hypertensive urgency is associated with a high risk for cardiovascular events and mortality in the United States and Europe, but data from low-income countries and interventions to improve outcomes are lacking. METHODS We conducted a 1-year prospective study of the prevalence and outcomes of hypertensive urgency (blood pressure (BP) ≥180 mm Hg/120 mm Hg without end-organ damage) in a busy outpatient clinic in Tanzania. RESULTS Of 7,600 consecutive adult outpatients screened with 3 unattended automated BP measurements according to standard protocol, the prevalence of hypertensive crisis was 199/7,600 (2.6%) (BP ≥180 mm Hg/120 mm Hg) and the prevalence of hypertensive urgency was 164/7,600 (2.2%). Among 150 enrolled patients with hypertensive urgency, median age was 62 years (54–68), 101 (67.3%) were women, and 53 (35%) were either hospitalized or died within 1 year. In a multivariate model, the strongest predictor of hospitalization/death was self-reported medication adherence on a 3 question scale (hazard ratio: 0.06, P < 0.001); 90% of participants with poor adherence were hospitalized or died within 1 year. CONCLUSIONS Patients with hypertensive urgency in Africa are at high risk of poor outcomes. Clinicians can identify the patients at highest risk for poor outcomes with simple questions related treatment adherence. New interventions are needed to improve medication adherence in patients with hypertensive urgency.

scholarly journals The Association Between Medicare Low-Income Subsidy and Anticancer Treatment Uptake in Advanced Lung Cancer

2019 ◽  
Vol 112 (6) ◽  
pp. 637-646 ◽  
Author(s):  
Yi-Ting Chou ◽  
Joel F Farley ◽  
Thomas E Stinchcombe ◽  
Amber E Proctor ◽  
Jennifer Elston Lafata ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Confidence Interval ◽  
Low Income ◽  
Advanced Nsclc ◽  
Statistical Tests ◽  
Advanced Lung Cancer ◽  
Part D ◽  
Treatment Uptake ◽  
Anticancer Treatment ◽  
Out Of Pocket Costs

Abstract Background High out-of-pocket costs may impact anticancer treatment uptake. The Low-Income Subsidy (LIS) program can reduce patient out-of-pocket cost for Medicare Part D–covered treatments. We examined whether the LIS increased uptake and reduced time to initiate orally administered anticancer drugs in patients with advanced non–small cell lung cancer (NSCLC). Methods Using Surveillance, Epidemiology and End Results (SEER)-Medicare data, we identified older adults (aged 65 years and older) diagnosed with advanced NSCLC from 2007 through 2013 and categorized them as full LIS, partial LIS, or non-LIS. We used propensity-score weighted (IPTW) Cox proportional hazards regression to assess the likelihood of and time to initiate Part D treatments. Part B medication uptake was our negative control because supplemental insurance reduces out-of-pocket costs for those drugs. All statistical tests were two-sided. Results Among 19 746 advanced NSCLC patients, approximately 10% initiated Part D treatments. Patients with partial or no LIS were less likely to initiate Part D treatments than were those with full subsidies (partial LIS vs full LIS HRIPTW = 0.77, 95% confidence interval = 0.62 to 0.97; non-LIS vs full LIS HRIPTW = 0.87, 95% confidence interval  = 0.79 to 0.95). Time to initiate Part D treatments was also slightly shorter among full-LIS patients (full LIS mean [SD] = 10.8 [0.04] months; partial LIS mean [SD] = 11.3 [0.08] months; and non-LIS mean [SD] = 11.1 [0.03] months, P < .001). Conversely, patients with partial or no LIS had shorter time to initiation of Part B drugs. Conclusions Patients receiving the full LIS had higher orally administered anticancer treatment uptake than patients without LIS. Notably, patients with partial LIS had the lowest treatment uptake, likely because of their low incomes combined with high expected out-of-pocket spending. High out-of-pocket costs for Part D medications may be a barrier to treatment use for patients without full LIS.

scholarly journals Mind the Gap: Why Closing the Doughnut Hole Is Insufficient for Increasing Medicare Beneficiary Access to Oral Chemotherapy

2016 ◽  
Vol 34 (4) ◽  
pp. 375-380 ◽  
Author(s):  
Stacie B. Dusetzina ◽  
Nancy L. Keating
Keyword(s):  
Prescription Drug ◽  
Low Income ◽  
Cost Sharing ◽  
Medicare Beneficiary ◽  
Interquartile Range ◽  
Medicare Beneficiaries ◽  
Before And After ◽  
Prescription Drug Plan ◽  
Typical Treatment ◽  
Out Of Pocket Costs

Purpose Orally administered anticancer medications are among the fastest growing components of cancer care. These medications are expensive, and cost-sharing requirements for patients can be a barrier to their use. For Medicare beneficiaries, the Affordable Care Act will close the Part D coverage gap (doughnut hole), which will reduce cost sharing from 100% in 2010 to 25% in 2020 for drug spending above $2,960 until the beneficiary reaches $4,700 in out-of-pocket spending. How much these changes will reduce out-of-pocket costs is unclear. Methods We used the Medicare July 2014 Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from the Centers for Medicare & Medicaid Services for 1,114 stand-alone and 2,230 Medicare Advantage prescription drug formularies, which represent all formularies in 2014. We identified orally administered anticancer medications and summarized drug costs, cost-sharing designs used by available plans, and the estimated out-of-pocket costs for beneficiaries without low-income subsidies who take a single drug before and after the doughnut hole closes. Results Little variation existed in formulary design across plans and products. The average price per month for included products was $10,060 (range, $5,123 to $16,093). In 2010, median beneficiary annual out-of-pocket costs for a typical treatment duration ranged from $6,456 (interquartile range, $6,433 to $6,482) for dabrafenib to $12,160 (interquartile range, $12,102 to $12,262) for sunitinib. With the assumption that prices remain stable, after the doughnut hole closes, beneficiaries will spend approximately $2,550 less. Conclusion Out-of-pocket costs for Medicare beneficiaries taking orally administered anticancer medications are high and will remain so after the doughnut hole closes. Efforts are needed to improve affordability of high-cost cancer drugs for beneficiaries who need them.

scholarly journals Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

2013 ◽  
Vol 28 (7) ◽  
pp. 876-885 ◽  
Author(s):  
Naomi C. Sacks ◽  
James F. Burgess ◽  
Howard J. Cabral ◽  
Steven D. Pizer ◽  
Marie E. McDonnell
Keyword(s):  
Medication Adherence ◽  
Cost Sharing ◽  
Medicare Beneficiaries ◽  
Part D

scholarly journals Addressing Insulin Access and Affordability: An Endocrine Society Position Statement

2021 ◽  
Vol 106 (4) ◽  
pp. 935-941
Author(s):  
Keyword(s):  
Low Income ◽  
Position Statement ◽  
Medicare Beneficiaries ◽  
Endocrine Society ◽  
Part D ◽  
Life Saving ◽  
Medicare Part B ◽  
Patients With Diabetes ◽  
Donut Hole ◽  
Access And Affordability

Abstract Rising costs have made access to affordable insulin far more difficult for people with diabetes, especially low-income individuals, those on high deductible health plans, beneficiaries using Medicare Part B to cover insulin delivered via pump, Medicare beneficiaries in the Part D donut hole, and those who turn 26 and must transition from their parents’ insurance, to manage their diabetes and avoid unnecessary complications and hospitalizations. For many patients with diabetes, insulin is a life-saving medication. Policymakers should immediately address drivers of rising insulin prices and implement solutions that would reduce high out-of-pocket expenditures for patients. The Endocrine Society recommends policy options to expand access to lower cost insulin in this paper.

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

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.

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

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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