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 Evaluating Medicare Performance: Perceptions of Performance Pre- and Post- ACA

2020 ◽  
Vol 7 (2) ◽  
pp. 28
Author(s):  
Ashleigh Chinelo Oguagha ◽  
Nickesha Joan Lambert
Keyword(s):  
Low Income ◽  
Medicare Beneficiary ◽  
National Level ◽  
Life Time ◽  
The Elderly ◽  
The United States ◽  
Health Coverage ◽  
Single Payer ◽  
Before And After ◽  
Performance Perceptions

Medicare is a national single-payer system that provides health coverage for the elderly, disabled, and terminally ill in the United States. Rising enrollment, costs, and decreases in financing options may affect the way Medicare performs. This study aimed to investigate participants’ perceptions of Medicare performance before and after the Affordable Care Act. A 3-part questionnaire was created and validated for use in this study. Respondents affiliated with several social work agencies were invited via email to participate in this study. 287 out of 519 invited questionnaires were used in data analyses. 27.5% of respondents reported being currently enrolled in Medicare, while 33.2% reported lifetime enrollment. Overall, retired/disabled, elderly and low-income participants reported currently or ever using Medicare. One’s perception of Medicare performance was determined by their status as a Medicare beneficiary. Medicare service efficacy was rated more positively over-time by current and life-time enrollees; additionally, Medicare performance was determined to be better in 2013 than in 2009. Ultimately, this study showed that health service and financial fairness factors are indicative of Medicare performance. Additional research should explore possible implications for the healthcare field as well as formulate a broad range of possible management and/or improvement strategies. Lastly, differences in performance across years can inform decision-makers and bolster the fundamental foundation of health policies at the state and national level.

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.

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 Using an Online Decision Aid to Help Medicare Beneficiaries Choose a Prescription Drug Plan

2020 ◽  
Author(s):  
M Bundorf ◽  
Cheryl Stults ◽  
Roman Klimke ◽  
Amy Meehan ◽  
Albert Chan ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Decision Aid ◽  
Medicare Beneficiaries ◽  
Drug Plan ◽  
Prescription Drug Plan

scholarly journals The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures

2018 ◽  
Vol 77 (1) ◽  
pp. 19-33 ◽  
Author(s):  
Joelle Abramowitz
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Low Income ◽  
Family Income ◽  
Before And After ◽  
Health Insurance Premiums ◽  
Using Data ◽  
Medicaid Expansions ◽  
Cutoff Levels ◽  
Out Of Pocket Costs

This article considers the extent to which Affordable Care Act state Medicaid expansions alleviated the burden of out-of-pocket costs associated with obtaining health insurance and medical care using data from the 2011 to 2016 Current Population Survey Annual Social and Economic Supplement. Using a difference-in-differences framework, the analysis examines effects of the Medicaid expansions on out-of-pocket expenditures for health insurance premiums and medical care, comparing expenditures across expansion and nonexpansion states before and after the expansions were implemented, performing separate analyses for individuals with family income at various eligibility cutoff levels in the first and second years of expansion implementation. The findings suggest that the expansions were associated with a relatively larger likelihood of having zero premium expenditures and of having zero nonpremium medical out-of-pocket expenditures for low-income individuals. These findings suggest that the expansions were effective in reducing medical out-of-pocket expenditures.

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.

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