Characteristics of Medicare Part D Beneficiaries Who Reach the Drug Benefit Threshold in Both of the First Two Years of the Part D Benefit
ABSTRACT Medicare Part D beneficiaries who reach the drug benefit threshold (DBT) risk adverse health outcomes.
We explore clinical characteristics of beneficiaries who repeatedly reach the DBT during the first 2 years of Medicare Part D and may benefit from proactive identification for medication and care management.
25,320 Medicare Advantage beneficiaries of whom 536 reached the DBT in 2006 only, ("2006 only"); 961 reached the DBT in 2006 and 2007 ("both years"); and 23,823 in neither year.
We assessed repeatedly reaching the DBT (relative to 2006 only) as a function of demographics, morbidity (specific conditions and overall burden), medication use (specific classes and overall burden), utilization, and use of catastrophic and/or additional pharmacy benefits.
Those who reached the DBT in both years had higher morbidity and utilization. In multivariate analyses, they were more likely than the 2006 only group to have one or more of 5 conditions (chronic pulmonary disease, dementia, depression, incontinence, and Parkinson disease), and within these conditions were more likely to use categories of trade-name medications for which there are limited available generic alternatives.
Repeatedly reaching the DBT is a function of the extent and chronicity of disease burden and is characterized by conditions for which there is limited availability of generic medications, and associated common comorbidities. If these findings are confirmed, strategies at practice and policy levels may help such Medicare beneficiaries avoid unnecessary out of pocket expenditures on medications from prematurely reaching the DBT.
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ABSTRACT: To describe the proportion of elderly Medicare advantage prescription drug plan (MAPDP) enrollees who meet or exceed the Medicare Part D doughnut hole (DH) entry threshold in 2 consecutive years and which characteristics put them at risk for repeated DH entry. One cohort of MAPDP enrollees ≥65 years of age with at least 1 month of eligibility in both 2006 and 2007, and a second cohort of enrollees with at least 1 month of eligibility in both 2007 and 2008. Descriptive statistics were used to compare characteristics of MAPDP enrollees who attained the DH entry threshold in 2 consecutive years with MAPDP enrollees who attained this threshold in only 1 or neither of these years. Adjusted odds ratios of the likelihood of repeatedly entering the DH were obtained using multivariate generalized estimating equations. The percent of MAPDP enrollees who attained the DH entry threshold in 2 consecutive years was low: 7% of enrollees in the 2006/2007 cohort and 6% of the 2007/2008 cohort. Likelihood of repeatedly entering the DH compared with not entering the DH in 2 consecutive years was significantly higher among MAPDP enrollees with multiple comorbidities and who were ≥74 years of age or female. A small subset of Medicare beneficiaries with significantly increased risk of repeatedly entering the DH may receive financial protection from closing of the DH as enacted in recent healthcare reform.Medical care 03/2011; 49(5):436-42. DOI:10.1097/MLR.0b013e31820f0eb6 · 2.94 Impact Factor
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ABSTRACT: In 2006, the US Centers for Medicare and Medicaid Services implemented Medicare Part D to provide outpatient prescription drug insurance to disabled and older adults. In creating Part D, a key provision to address quality included medication therapy management (MTM) programmes designed to increase proper and safe use of medications among targeted Part D beneficiaries. A preponderance of evidence shows that Part D has increased medication affordability and accessibility; however, what remains less clear is whether it has improved the quality of medication use and optimized health outcomes. Now in its sixth year, Part D is undergoing its first major revision, with the gradual elimination of the coverage gap by 2020. Therefore, now is a good time to review the accumulated evidence on the impact of Part D and MTM programmes on the quality of medication use to help inform future policy decisions and research directions. In this review, we found that Part D's net effect on quality of medication use has mainly been positive. Cost-related medication nonadherence improved moderately and there were fewer than expected treatment interruptions. However, vulnerable subgroups, such as sicker and dual-eligible beneficiaries, experienced lags in improvement. Beneficiaries who entered the coverage gap consistently experienced interruptions and displayed worsening medication adherence after entering the gap, with generic-only gap drug coverage offering limited benefit. Such findings can serve as baseline information as the coverage gap phases out. Limited availability of data is the greatest barrier to research into Part D. Part D's overall effect on health outcomes and adverse medical events, such as hospitalizations, is inconclusive because of inadequate evidence to date. Similarly, no evaluation of quality of medication use is available with respect to utilization management strategies and MTM programmes delivered under Part D. Future research will need to further examine the added value of Part D and address whether Part D optimizes health outcomes in the Medicare population. As the current economic recession increases the pressure to cut costs, the effect of future spending restrictions, such as restrictions on coverage subsidies, will also be of special concern.Drugs & Aging 10/2011; 28(10):797-807. DOI:10.2165/11595250-000000000-00000 · 2.50 Impact Factor
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ABSTRACT: The objective of this cross-sectional, retrospective, claims-based analysis was to evaluate disease-specific quality measures, use of acceptable therapies, and health care cost and utilization among Medicare Advantage Part D (MAPD) enrollees overall and by income/subsidy eligibility status. Individuals aged ≥65 years with evidence of ≥1 of 8 common conditions and continuously enrolled in a MAPD plan throughout 2007 were assigned to low-income/dually eligible (LI/DE) or non-LI/DE cohorts. Quality of care metrics were calculated for asthma, chronic obstructive pulmonary disease (COPD), diabetes, and new episode depression. Persistence (proportion with percentage of days covered ≥80%), compliance (proportion with medication possession ratio ≥80%), health care costs, and utilization metrics were assessed by condition. All measures were evaluated for calendar year 2007. Bivariate comparisons were made between all LI/DE and non-LI/DE subgroups. A total of 183,213 patients were included. Metrics showed deficiencies in quality of care overall but generally favored non-LI/DE patients. The proportion of patients filling acceptable medication was suboptimal for most conditions, ranging from 40% to 96% across conditions and cohorts, with COPD the lowest and heart failure (HF) the highest. LI/DE patients were significantly more likely than non-LI/DE patients to fill acceptable therapy in each disease group (P<0.001) except HF. Percentages persistent and compliant with acceptable therapies were lowest for asthma and COPD, and highest for HF; percentages were generally higher among LI/DE patients. Mean disease-specific health care costs ranged from $345 (hyperlipidemia) to $2086 (HF) and were significantly higher for LI/DE than for non-LI/DE enrollees (P<0.001) for all diseases except coronary artery disease and HF. Overall, quality indicators, use of acceptable medications, and persistence/compliance metrics were suboptimal. Quality metrics favored non-LI/DE patients but medication metrics favored LI/DE patients. With an aging population and increasing health care costs, the deficits identified highlight the need for comprehensive strategies to improve clinical and economic outcomes across diseases.Population Health Management 02/2012; 15(2):101-12. DOI:10.1089/pop.2011.0008 · 1.35 Impact Factor