Decreased Antihyperglycemic Drug Use Driven by High Out-of-Pocket Costs Despite Medicare Coverage Gap Closure

ABSTRACTObjective:To determine whether closing the Part D coverage gap (“donut hole”) between 2010 and 2019 lowered patients’ out-of-pocket costs for disease-modifying therapies (DMTs) for multiple sclerosis (MS).Methods:Using nationwide Medicare Formulary and Drug Pricing Files, we analyzed Part D drug benefit design and DMT prices in 2010, 2016, and 2019. We calculated average monthly list prices for DMTs available in each year (4 DMTs in 2010, 11 DMTs in 2016, and 14 DMTs in 2019). We projected patients’ annual out-of-pocket cost for each DMT alone under a standard Part D plan in that year. We estimated potential savings attributable to closing the coverage gap between 2010 to 2019 (beneficiaries’ cost-sharing dropped from 100% to 25%) under three scenarios; no increase in price, an inflation-indexed price increase (3% annually), and the observed price increase.Results:Median monthly DMT prices rose from $2804, $5987, to $7009 over the years 2010, 2016, and 2019 respectively. Median projected annual out-of-pocket costs rose from $5916, $6229, to $6618. With unchanged or inflation-indexed DMT prices changes, closing the coverage gap would have reduced annual out-of-pocket costs by $2260 (38% reduction) and $1744 (29% reduction) respectively. Despite having the lowest monthly price, generic glatiramer acetate had among the highest out-of-pocket costs ($6731 to $6939 a year) in 2019.Conclusions:Medicare Part D beneficiaries can pay thousands of dollars yearly out-of-pocket for DMTs. Closing the Part D coverage gap did not reduce out-of-pocket costs for patients because of simultaneous increases in DMT prices.

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PNS69 THE MEDICARE PART D COVERAGE GAP CLOSURE, PRICE SENSITIVITY, AND UTILIZATION: WHICH DRUG CLASSES SAW THE LARGEST EFFECT?

Value in Health ◽

10.1016/j.jval.2020.04.1072 ◽

2020 ◽

Vol 23 ◽

pp. S295

Author(s):

C. Kaplan ◽

T. Hayes

Keyword(s):

Medicare Part D ◽

Medicare Part ◽

Price Sensitivity ◽

Part D ◽

Coverage Gap ◽

Gap Closure ◽

Drug Classes

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Decreased antihyperglycemic drug use driven by high out-of-pocket costs despite Medicare coverage gap closure

10.2337/figshare.12453773 ◽

2020 ◽

Author(s):

Mugdha Gokhale ◽

Stacie B. Dusetzina ◽

Virginia Pate ◽

Danielle S Chun ◽

John B. Buse ◽

...

Keyword(s):

Low Cost ◽

Seasonal Pattern ◽

Cox Models ◽

Part D ◽

Dipeptidyl Peptidase 4 ◽

Coverage Gap ◽

Hazard Ratios ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Before And After ◽

Out Of Pocket Costs

<a>Objectives</a>: <a>Using the 2016 Medicare part D coverage gap as an example, we explored effects of increased out-of-pocket costs on adherence to branded </a>dipeptidyl peptidase-4 inhibitors (DPP-4i) in patients without financial subsidies, relative to subsidized patients who do not experience increased spending during the gap. We also explored seasonality of re-initiation, as discontinuers may be more likely to reinitiate in January when benefits reset. Methods: DPP-4i or sulfonylureas initiators, aged >66 years, from a 20% sample of 2015-2016 Medicare claims were identified. We used difference-in-differences Poisson regression to compare adherence before and after entering the coverage gap between non-subsidized and subsidized patients. Among discontinuers, monthly hazard ratios (HRs) for re-initiation relative to January 2016 were derived with Cox models. As a second control, we repeated analyses using sulfonylureas, generic low-cost alternatives. Results: In 2016, 8,096 subsidized and 6,173 non-subsidized DPP-4i initiators entered the coverage gap. Non-subsidized patients, copayment in the coverage gap was 45% ($227 per DPP-4i prescription), and adherence decreased from 68.4% to 49.0% after gap entry. Accounting for adherence differences in subsidized patients, non-subsidized patients demonstrated reduced adherence to DPP-4is [Difference-in-difference:-16.9%;CI(-18.7%,-15.1%)] but not sulfonylureas [-1.6%(-3.4%,0.2%)]. Re-initiation was lowest in the months before January (HR=0.4-0.5) among non-subsidized DPP-4i patients, demonstrating a strong seasonal pattern. Conclusions: Increased out-of-pocket costs negatively affect adherence and re-initiation of branded antihyperglycemic drugs among patients without financial subsidies. Despite closure of the coverage gap, affordability remains a concern given increasing list prices for many drugs on Medicare and the growing use of deductibles and coinsurance by commercial health plans.

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Medicare coverage gap may prompt some patients with diabetes to cut back on their medicines

PsycEXTRA Dataset ◽

10.1037/e504442010-016 ◽

2009 ◽

Keyword(s):

Coverage Gap ◽

Medicare Coverage ◽

Patients With Diabetes

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Impact of the Medicare Part D Coverage Gap Closure and Generic Entry on Medication Use

SSRN Electronic Journal ◽

10.2139/ssrn.3690078 ◽

2020 ◽

Author(s):

Cameron Kaplan ◽

Yuting Zhang ◽

Judith Liu

Keyword(s):

Medication Use ◽

Medicare Part D ◽

Medicare Part ◽

Part D ◽

Generic Entry ◽

Coverage Gap ◽

Gap Closure

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Decreased antihyperglycemic drug use driven by high out-of-pocket costs despite Medicare coverage gap closure

10.2337/figshare.12453773.v1 ◽

2020 ◽

Author(s):

Mugdha Gokhale ◽

Stacie B. Dusetzina ◽

Virginia Pate ◽

Danielle S Chun ◽

John B. Buse ◽

...

Keyword(s):

Low Cost ◽

Seasonal Pattern ◽

Cox Models ◽

Part D ◽

Dipeptidyl Peptidase 4 ◽

Coverage Gap ◽

Hazard Ratios ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Before And After ◽

Out Of Pocket Costs

<a>Objectives</a>: <a>Using the 2016 Medicare part D coverage gap as an example, we explored effects of increased out-of-pocket costs on adherence to branded </a>dipeptidyl peptidase-4 inhibitors (DPP-4i) in patients without financial subsidies, relative to subsidized patients who do not experience increased spending during the gap. We also explored seasonality of re-initiation, as discontinuers may be more likely to reinitiate in January when benefits reset. Methods: DPP-4i or sulfonylureas initiators, aged >66 years, from a 20% sample of 2015-2016 Medicare claims were identified. We used difference-in-differences Poisson regression to compare adherence before and after entering the coverage gap between non-subsidized and subsidized patients. Among discontinuers, monthly hazard ratios (HRs) for re-initiation relative to January 2016 were derived with Cox models. As a second control, we repeated analyses using sulfonylureas, generic low-cost alternatives. Results: In 2016, 8,096 subsidized and 6,173 non-subsidized DPP-4i initiators entered the coverage gap. Non-subsidized patients, copayment in the coverage gap was 45% ($227 per DPP-4i prescription), and adherence decreased from 68.4% to 49.0% after gap entry. Accounting for adherence differences in subsidized patients, non-subsidized patients demonstrated reduced adherence to DPP-4is [Difference-in-difference:-16.9%;CI(-18.7%,-15.1%)] but not sulfonylureas [-1.6%(-3.4%,0.2%)]. Re-initiation was lowest in the months before January (HR=0.4-0.5) among non-subsidized DPP-4i patients, demonstrating a strong seasonal pattern. Conclusions: Increased out-of-pocket costs negatively affect adherence and re-initiation of branded antihyperglycemic drugs among patients without financial subsidies. Despite closure of the coverage gap, affordability remains a concern given increasing list prices for many drugs on Medicare and the growing use of deductibles and coinsurance by commercial health plans.

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