Prescription drug plan enrollment and patient outcomes in Medicare Part D beneficiaries with diabetes

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Last Modified
  • March 22, 2019
Creator
  • Geonnotti, Kristin L.
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Medicare Part D aims to provide seniors with affordable prescription drug coverage. However, beneficiaries' out-of-pocket costs may vary widely between plans. For Part D to be most effective, beneficiaries should enroll into the prescription drug plan that minimizes total annual out-of-pocket costs. However, several factors, including complex enrollment processes, may result in beneficiaries' failure to enroll into a lowest-cost plan. This study examines the prevalence and effect of being in a lowest-cost plan on patient outcomes, including: cost-related nonadherence (CRN); clinical outcomes; and health services use among Part D beneficiaries with diabetes. We identified patients with diabetes who were [greater than or equal to] 65 years and received primary care from UNC's General Internal Medicine or Family Medicine practices. We combined data from telephone surveys, medical records, and publicly-available CMS cost data. Based on prescribed medications, we calculated: (1) total out-of-pocket medication costs and (2) out-of-pocket medication costs if they were enrolled in a lowest-cost plan. Differential costs are the difference between the total and lowest out-of-pocket costs. These calculations were made twice: once assuming that prescriptions were filled as written, and again with generic substitutions. Descriptive and multivariate regression analyses were used to examine all aims. 75% of beneficiaries are not in lowest-cost plans. Differential costs are substantial: 50% of participants are in a plan that costs them at least $715 ("as written") / $489 ("generic") more than the lowest-cost plan, with a highest difference of over $7,500. On average, participants are paying 30% more than necessary to obtain medications. Additionally, a $1,000 increase in as written differential costs is associated with a 36% increase in the odds of experiencing CRN (p<0.05). In turn, CRN is associated with poorer outcomes including self-reported health status and increased inpatient stays. To my knowledge, this is the first prospective cohort study to link patients' plan, CRN and clinical parameters to evaluate Part D. By considering policies that increase the likelihood of beneficiaries being enrolled in a lowest-cost plan, CMS has the potential to reduce CRN and improve patients' health outcomes.
Date of publication
DOI
Resource type
Rights statement
  • In Copyright
Note
  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Policy and Management.
Advisor
  • Weinberger, Morris
Language

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details Prescription drug plan enrollment and patient outcomes in Medicare Part D beneficiaries with diabetes 2019-04-12 Public Download