Impact of Medicare Part D on Utilization and Expenditures
ABSTRACT
Objective: To compare pharmacy use and expenditures under a capped benefi t in a Medicare+Choice (M+C) plan in 2005 and under a Part D benefi t in 2006.
Study Design: Longitudinal comparison of benefi ciaries’ behaviors before and after implementation of Part D.
Methods: Sample members, including a subset with hypertension, diabetes, dyslipidemia, or congestive heart failure, were M+C benefi ciaries in 2005 who switched to a Medicare Advantage plan in 2006. Differences in prescription use and adherence were estimated using generalized estimating equations and logistic regression models. Expenditure data were estimated using bootstrap methods.
Results: In 2005, 36.73% of members met the $600 brand-name cap; 29.5% reached the gap in 2006. There was a 17.5% increase in all prescriptions in 2006, which translated into 20.8% and 13.63% increases in the use of generic and brand-name medications, respectively. Also, 6% more members purchased prescriptions in 2006. For all diseases, the number of persistent members increased in 2006. After removal of members who reached the gap, members still experienced a 12.76% increase in out-of-pocket expenditures for all prescriptions.
Conclusions: Findings suggest that despite a restrictive gap in 2006, use of prescription medications increased for members who faced a cap on brand-name medications. Restrictions in pharmacy benefi ts may not deter utilization for Part D as previously thought. Possible reasons could include perception of richer prescription benefi ts by members under Part D compared with previous coverage or an increased motivation to better manage their health due to availability of richer benefits.
(Am J Pharm Benefits. 2010;2(3):209-218)
Objective: To compare pharmacy use and expenditures under a capped benefi t in a Medicare+Choice (M+C) plan in 2005 and under a Part D benefi t in 2006.
Study Design: Longitudinal comparison of benefi ciaries’ behaviors before and after implementation of Part D.
Methods: Sample members, including a subset with hypertension, diabetes, dyslipidemia, or congestive heart failure, were M+C benefi ciaries in 2005 who switched to a Medicare Advantage plan in 2006. Differences in prescription use and adherence were estimated using generalized estimating equations and logistic regression models. Expenditure data were estimated using bootstrap methods.
Results: In 2005, 36.73% of members met the $600 brand-name cap; 29.5% reached the gap in 2006. There was a 17.5% increase in all prescriptions in 2006, which translated into 20.8% and 13.63% increases in the use of generic and brand-name medications, respectively. Also, 6% more members purchased prescriptions in 2006. For all diseases, the number of persistent members increased in 2006. After removal of members who reached the gap, members still experienced a 12.76% increase in out-of-pocket expenditures for all prescriptions.
Conclusions: Findings suggest that despite a restrictive gap in 2006, use of prescription medications increased for members who faced a cap on brand-name medications. Restrictions in pharmacy benefi ts may not deter utilization for Part D as previously thought. Possible reasons could include perception of richer prescription benefi ts by members under Part D compared with previous coverage or an increased motivation to better manage their health due to availability of richer benefits.
(Am J Pharm Benefits. 2010;2(3):209-218)
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