scholarly journals The Value of Experience: Differences in Knowledge among Medicare Beneficiaries

2005 ◽  
Vol 42 (3) ◽  
pp. 266-280
Author(s):  
Merrile Sing ◽  
Beth Stevens
Keyword(s):  
Managed Care ◽  
Prescription Drug ◽  
Formal Education ◽  
Life Experience ◽  
Care Plan ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Drug Benefits ◽  
Prescription Drug Plan ◽  
Prescription Drug Benefits

The Medicare Advantage program gives Medicare beneficiaries the opportunity to choose from an array of insurance options instead of receiving prescribed benefits. In 2006, beneficiaries who want prescription drug benefits will need to enroll in a Medicare managed care plan or a private prescription drug plan. To examine awareness and use of Medicare information programs, and the extent to which these programs are associated with beneficiary knowledge about Medicare and managed care, we conducted a national survey of Medicare beneficiaries six to 12 months after the nationwide mailing of the Medicare & You 2000 handbook. Beneficiary information-gathering behavior and experience with Medicare managed care were more highly associated with knowledge about Medicare managed care than formal education, age, income, or membership in a managed care plan before enrolling in Medicare. Practical life experience appears to outweigh traditional factors in beneficiary knowledge of Medicare and managed care.

Substitution, Spending Offsets, and Prescription Drug Benefit Design

2007 ◽  
Vol 10 (2) ◽  
Author(s):  
Martin Gaynor ◽  
Jian Li ◽  
William B Vogt
Keyword(s):  
Prescription Drug ◽  
Prescription Drugs ◽  
Outpatient Care ◽  
Drug Benefit ◽  
Medicare Beneficiaries ◽  
Benefit Design ◽  
Prescription Drug Benefit ◽  
Drug Benefits ◽  
Prescription Drug Use ◽  
Prescription Drug Benefits

Many U.S. employers have recently adopted less generous prescription drug benefits. In addition, in 2006 the U.S. began to offer prescription drug insurance to approximately 42 million Medicare beneficiaries. We used data on individual health insurance claims and benefit data from 1997 to 2003 to study how changes in consumers’ co-payments for prescription drugs affect use of and expenditure on prescription drugs, inpatient care, and outpatient care. We analyzed the effects both in the year of the co-payment change and in the year following the change. Our results show that increases in prescription drug prices reduce both use of and spending on prescription drugs. They also show that consumers substitute the use of outpatient care for prescription drug use and that about 35% of the expenditure reductions on prescription drugs are offset by increases in other spending.

scholarly journals Cost-related Medication Nonadherence among Medicare Beneficiaries with Cardiovascular Disease Risk Factors: The Role of Comprehension of the Medicare Program and its Prescription Drug Benefits

2021 ◽  
Author(s):  
Chanhyun Park ◽  
Angela Chang ◽  
Boon Ng ◽  
Gary Young
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Prescription Drug ◽  
Medicare Beneficiaries ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Drug Benefits ◽  
Medicare Program ◽  
Obesity Hypertension ◽  
Prescription Drug Benefits

RATIONALE, AIMS, AND OBJECTIVES: This study aims to investigate how reported comprehension of the Medicare program and its prescription drug benefits affects cost-related medication nonadherence (CRN) among Medicare beneficiaries with cardiovascular disease (CVD) risk factors. METHODS: This cross-sectional study used the 2017 Medicare Current Beneficiary Survey Public Use File data and included Medicare beneficiaries aged ≥ 65 years who reported having at least one CVD risk factor (i.e., hypertension, hyperlipidemia, diabetes, smoking, and obesity) (n=2,821). A survey-weighted logistic model was used to examine associations between lack of difficulty understanding the Medicare program and its prescription drug benefits and CRN, controlling for beneficiaries’ demographic (e.g., age) and clinical characteristics (e.g, comorbidities). This study further analyzed five subgroups based on the type of CVD risk factors involved. RESULTS: Among Medicare beneficiaries with CVD risk factors, 14.4% reported CRN. Medicare beneficiaries with CVD risk factors who reported difficulty understanding the overall Medicare program and its prescription drug benefits were more likely to report CRN, compared to those who reported easy understanding of the overall Medicare program (OR=1.49; 95% CI=1.09, 2.04; p<0.001) and its prescription drug benefits (OR=2.01; 95% CI=1.51, 2.67; p<0.001). Similar results were obtained for the subgroups with obesity, hypertension, or hyperlipidemia. CONCLUSIONS: Perceived lack of difficulty understanding the Medicare Program and its prescription drug benefits has a positive impact on CRN reduction among Medicare beneficiaries with CVD risk factors, especially those with obesity, hypertension or hyperlipidemia. Monitoring and enhancing Medicare beneficiaries’ overall understanding of the Medicare program may reduce CRN.

Abstract 9: Alirocumab Prior Authorization Approval and Prescription Fill Rates Among Medicare Advantage Patients in a Large US Managed Care Plan

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Kelley C Dacus ◽  
Libby Horter ◽  
Jennifer Hayden ◽  
Raymond A Harvey ◽  
Stephen Thompson ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Low Income ◽  
Care Plan ◽  
Atherosclerotic Cardiovascular Disease ◽  
Prior Authorization ◽  
Medicare Advantage ◽  
Pcsk9 Inhibitor ◽  
Prescription Claim ◽  
Pharmacy Claims ◽  
Dual Eligibility

Introduction: Alirocumab is a proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitor approved as an adjunct to diet and maximally tolerated statin therapy for treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease who require additional lowering of LDL-cholesterol. Barriers to possession, including therapy cost and cost-sharing implications, may contribute to low utilization of this therapy. Objective: To explore differences in demographic and clinical characteristics between patients with prior authorization (PA) approvals or denials for alirocumab as evidenced through filled alirocumab prescription claims. Methods: A retrospective claims-based database analysis of patients with a Medicare Advantage Prescription Drug (MAPD) plan was conducted to identify patients with evidence of a PA approval for alirocumab. Among the group of patients with a PA for alirocumab, the pharmacy claims database was searched for evidence of a corresponding prescription claim within 30 days following the first PA request (index date). The analysis was stratified by evidence of Federal low income subsidy (LIS) support, a program that provides extra assistance with prescription drug costs for eligible individuals whose income and resources are limited, and/ or dual eligibility (DE) status, eligible for Medicare and Medicaid, (LIS/DE) at index. Results: A total of 2,098 MAPD patients meeting study inclusion/exclusion criteria and with a PA for alirocumab were identified between March 1, 2016 and February 28, 2017. Non-LIS/DE patients comprised approximately 82% of the eligible population (n=1,730). There were several notable differences in baseline demographics between the non-LIS/DE vs. the LIS/DE cohorts with an approved PA claim, including Deyo-Charlson Comorbidity Index (2.2 vs. 3.0), prevalence of diabetes mellitus (39.2% vs. 54.7%), and prevalence of HeFH (11.8% vs. 15.6%). While the percentage of patients with an approved PA was similar between the LIS/DE and non-LIS/DE cohorts, 88.9% and 91.2%, respectively, substantially more patients in the LIS/DE cohort had evidence of alirocumab possession based on a paid claim (60.6%) vs. those in the non-LIS/DE cohort (17.3%). Conclusion: Although a high percentage of MAPD patients had evidence of an approved PA, there were notable differences in clinical and demographic characteristics between those with and without LIS/ DE status. Further, the proportion of patients with an approved PA and a paid prescription claim differed markedly amongst MAPD patients with and without LIS/DE status, suggesting further research is needed to understand potential barriers to obtaining PCSK9i therapy.

Medicare Part D Prescription Drug Benefits and Administrative Burden in the Care of Dually Eligible Psychiatric Patients

2008 ◽  
Vol 59 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Joshua E. Wilk ◽  
Joyce C. West ◽  
Donald S. Rae ◽  
Maritza Rubio-Stipec ◽  
Jennifer J. Chen ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Psychiatric Patients ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D ◽  
Drug Benefits ◽  
Administrative Burden ◽  
Prescription Drug Benefits

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.

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