How end-stage renal disease patients manage the Medicare Part D coverage gap
ABSTRACT Medicare Part D was enacted to help elderly and disabled individuals pay for prescription drugs, but it was structured with a gap providing no coverage in 2010 between $2,830 and $6,440. Patients with end-stage renal disease (ESRD) are especially likely to be affected due to high costs of dialysis-related drugs and the importance of adherence for overall health. Researchers from social work, pharmacy, and dietetics interviewed 12 patients with ESRD to learn about strategies and challenges during the coverage gap. Constant comparison generated the following themes: the experience of hitting the gap, management strategies, physical and emotional consequences, and advice for others. Results suggest that patients could benefit from greater involvement with professionals and peers to prepare for and manage their medications during the coverage gap and for support in dealing with emotional consequences and stress related to financial pressures and living with a serious health condition.
- [Show abstract] [Hide abstract]
ABSTRACT: The mechanisms used by Medicare beneficiaries who reached their Part D drug-benefit threshold to cope with the costs of prescription drugs were evaluated. A retrospective review of integrated medical and pharmacy electronic records and a mail survey were utilized. Members of a Medicare Advantage plan continuously enrolled in 2006 in either a standard drug-benefit plan who reached their threshold by October 1, 2006 (study group) or a retiree drug subsidy plan without a threshold but by October 1, 2006, had reached the threshold in total drug spend (control group) were included. Data on members' cost-lowering medication strategies, demographics, and socioeconomic status were analyzed. Of the 1,472 questionnaires mailed, 622 (42%) were completed. Respondents in the study group were more likely than control respondents to be male, be married, own a home, report lower health status, and have a household income of <$30,000 (p < 0.05). There were no significant differences in age, race or ethnicity, and diagnoses between groups. Study group respondents were three times more likely than control group respondents to use a cost-lowering strategy (p < 0.001). Predictors of increased risk of using a medication cost-lowering strategy included study group assignment, age, health status, education, income, and purchase of a second-generation antipsychotic (p < 0.05). Respondents in the study group were three times more likely than respondents in the control group to report using a medication cost-lowering strategy. Respondents who were younger and had limited prescription drug coverage, lower household income, higher educational status, and poorer health status were at increased risk of adopting a cost-lowering strategy.American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 06/2008; 65(11):1062-70. DOI:10.2146/ajhp070478 · 1.88 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Having annual dollar limits in prescription coverage is a type of benefit design unique to Medicare beneficiaries. This type of coverage is found predominantly within private Medigap policies and Medicare+Choice plans offering prescription coverage. The purpose of this study was to determine the impact of capped prescription benefits on efforts to reduce out-of-pocket prescription expenses by beneficiaries at risk for reaching their cap. This design was quasi-experimental, with data obtained from self-administered questionnaires mailed to 600 Medicare HMO risk enrollees with capped prescription benefits. Data were collected on 378 Medicare enrollees for a 63% response rate. Approximately half of all respondents participated in > or =1 strategy to reduce their out-of-pocket prescription expenses. Participation in selected strategies included obtaining samples from physicians (39.2%), taking less than prescribed amounts (23.6%), and discontinuing prescribed medications (16.3%). Additionally, 15% of respondents indicated going without necessities, and 12% indicated borrowing money to pay for their prescriptions. Those who reached their prescription cap were more likely to participant in any one behavior (odds ratio [OR], 2.18), more likely to take less medication than prescribed (OR, 2.83), more likely to discontinue a medication (OR, 3.36), and more likely to obtain samples from their physician (OR, 2.02) compared with those who had not reached their prescription cap. Beneficiaries at risk for reaching their prescription cap are taking steps to reduce their out-of-pocket prescription costs. Although some behaviors would be considered prudent, other behaviors may be placing beneficiaries at risk for drug-related morbidity and mortality.Medical Care 04/2001; 39(3):296-301. DOI:10.1097/00005650-200103000-00009 · 3.23 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Information on the effects of reaching the Medicare Part D standard drug benefit threshold is limited. Describe and compare pre- and post-threshold healthcare and medication utilization of Medicare beneficiaries who reach threshold relative to those who do not reach threshold and those who do not have a threshold. Retrospective study of 21,349 beneficiaries enrolled into a Medicare Direct Pay Plan with a standard threshold and 9088 Part D-eligible beneficiaries without a threshold. We used Poisson methods to compare utilization and conditional Poisson models to assess utilization changes. Medication adherence was determined. The 1237 (6%) beneficiaries who reached threshold were older, had greater morbidity, received more medications, and had more medical office visits (all P < 0.001) than beneficiaries who did not reach threshold. After adjustment, those who reached threshold had greater incidences of inpatient [risk ratio (IRR) = 1.85; 95% confidence interval (CI): 1.64-2.09] and emergency department use (IRR = 1.60; 95% CI: 1.40-1.83). After reaching threshold, primary care visits decreased compared with the same time frame in 2005 for those who reached threshold (IRR = 0.86; 95% CI: 0.79-0.93) and a matched group with no threshold (IRR = 0.88; 95% CI: 0.84-0.92). Adherence to chronic medications declined over time in both groups, but adherence decline was greater for beneficiaries who reached threshold. Beneficiaries who reach threshold are older, have more morbidity, and use more medications. Although medication adherence declines after reaching threshold, its association with changes in other healthcare utilization is not clear.Medical care 11/2008; 46(10):1116-22. DOI:10.1097/MLR.0b013e318185cddd · 3.23 Impact Factor