Effects of Medicare Part D on Medicaid-Medicare Dual Eligibles with HIV

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  • March 20, 2019
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  • Belenky, Nadya
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • The goal of this dissertation was to estimate the effects of Medicare Part D implementation on a range of outcomes in Medicaid-Medicare dual eligibles with HIV. Dual eligibles receive primary coverage from Medicare, while Medicaid provides wrap-around support, both financially and by covering services not included in Medicare coverage. When Medicare Part D was implemented in 2006, Medicaid-Medicare dual eligibles with HIV lost their prescription drug coverage through Medicaid and were auto-enrolled into a Medicare Part D prescription drug plan. Despite benefits to most Medicare enrollees, there were indications that, for dual eligibles, Medicare Part D was associated with mandated cost-sharing and other barriers to medication access. Using 2003-2008 data from the Women’s Interagency HIV Study, we created a propensity score matched cohort and used a difference-in-differences approach to compare dual eligibles’ outcomes pre- and post-Medicare Part D to those enrolled in Medicaid alone. The transition to Medicare Part D was associated with a sharp increase in the proportion of dual eligibles with self-reported out-of-pocket prescription drug costs, followed by a more gradual increase in the proportion of dual eligibles using AIDS Drug Assistance Programs (ADAP). Even though Medicare Part D was associated with increased out-of-pocket spending, that increase did not appear to compromise antiretroviral therapy (ART) adherence or antidepressant use. Further, HIV viral load suppression, depressive symptoms, and hospitalization remained stable after Medicare Part D implementation. It is possible that co-occurring increased ADAP use mitigated the increase in out-of-pocket spending, pointing to successful coordination between Medicare Part D and ADAP as well as the vital role of ADAP during insurance transitions for this vulnerable population. These results may also signal that Medicare Part D’s designation of ART and antidepressants as protected drug classes had its intended effect.
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  • In Copyright
Advisor
  • Oberlander, Jonathan
  • Edmonds, Andrew
  • Dusetzina, Stacie
  • Cole, Stephen
  • Pence, Brian
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016
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