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Medicare part D's impact on antipsychotic drug use and costs among elderly patients without prior drug insurance.

ABSTRACT: Medicare part D's implementation improved access to and affordability of prescription drugs for the elderly without prior drug insurance. Effects for specific drugs and drug classes are less well understood. We assessed part D's impact on antipsychotic medication (APM) utilization and out-of-pocket costs among elderly without prior drug insurance. Retail pharmacy claims from 3 nationwide pharmacy chains were used to analyze 2 time-series designs: (1) a policy model, to obtain a policymaker's perspective: what was the overall impact of part D on APM use and costs among elderly without drug insurance in 2005 with the opportunity to enroll? And (2) a clinical model, to obtain a clinician's perspective: what would happen to elderly without drug insurance in 2005 who did enroll in part D--would they be able to get APMs? At what cost? Subgroup analyses among part D enrollees evaluated potentially different effects for patients who received a subsidy and patients who used antidementia drugs. In the policy model, part D implementation was associated with a 5% increase in APM use and a 37% reduction in out-of-pocket costs, suggesting a modest need for APMs among all previously uninsured elderly. Patients who did enroll in part D (clinical model) had a 97% increase in APM use and a 62% decrease in out-of-pocket costs, suggesting that patients who needed APMs were able to access them at low cost through the part D program. Part D implementation was associated with increased use and affordability of APMs for the elderly without prior drug insurance.

SUBMITTER: Polinski JM

PROVIDER: S-EPMC3419531 | biostudies-literature | 2012 Feb

REPOSITORIES: biostudies-literature

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Medicare part D's impact on antipsychotic drug use and costs among elderly patients without prior drug insurance.

Polinski Jennifer M JM Brookhart M Alan MA Glynn Robert J RJ Schneeweiss Sebastian S

Journal of clinical psychopharmacology 20120201 1

Medicare part D's implementation improved access to and affordability of prescription drugs for the elderly without prior drug insurance. Effects for specific drugs and drug classes are less well understood. We assessed part D's impact on antipsychotic medication (APM) utilization and out-of-pocket costs among elderly without prior drug insurance. Retail pharmacy claims from 3 nationwide pharmacy chains were used to analyze 2 time-series designs: (1) a policy model, to obtain a policymaker's per ...[more]

PMID: 22198455

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Project description:BackgroundNations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the "coverage gap" during which beneficiaries are fully responsible for drug costs. We examined the impact of entering the coverage gap on drug discontinuation, switching to another drug for the same indication, and drug adherence. While increased discontinuation of and adherence to essential medications is a regrettable response, increased switching to less expensive but therapeutically interchangeable medications is a positive response to minimize costs.Methods and findingsWe followed 663,850 Medicare beneficiaries enrolled in Part D or retiree drug plans with prescription and health claims in 2006 and/or 2007 to determine who reached the gap spending threshold, n?=?217,131 (33%). In multivariate Cox proportional hazards models, we compared drug discontinuation and switching rates in selected drug classes after reaching the threshold between all 1,993 who had no financial assistance during the coverage gap (exposed) versus 9,965 multivariate propensity score-matched comparators with financial assistance (unexposed). Multivariate logistic regressions compared drug adherence (? 80% versus >80% of days covered). Beneficiaries reached the gap spending threshold on average 222 d ±79. At the drug level, exposed beneficiaries were twice as likely to discontinue (hazard ratio [HR] ?=?2.00, 95% confidence interval [CI] 1.64-2.43) but less likely to switch a drug (HR ?=?0.60, 0.46-0.78) after reaching the threshold. Gap-exposed beneficiaries were slightly more likely to have reduced adherence (OR ?=?1.07, 0.98-1.18).ConclusionsA lack of financial assistance after reaching the gap spending threshold was associated with a doubling in discontinuing essential medications but not switching drugs in 2006 and 2007. Blunt cost-containment features such as the coverage gap have an adverse impact on drug utilization that may conceivably affect health outcomes.

Project description:ImportanceRising pharmaceutical costs in the United States are an increasing source of financial burden for payers and patients. Although topical steroids are among the most commonly prescribed medications in dermatology, there are limited data on steroid-related spending and utilization.ObjectiveTo characterize Medicare and patient out-of-pocket costs for topical steroids, and to model potential savings that could result from substitution of the cheapest topical steroid from the corresponding potency class.Design, setting, and participantsThis study was a retrospective cost analysis of the Medicare Part D Prescriber Public Use File, which details annual drug utilization and spending on both generic and branded drugs from 2011 to 2015 by Medicare Part D participants who filled prescriptions for topical steroids.Main outcomes and measuresTotal and potential Medicare and out-of-pocket patient spending. Costs were adjusted for inflation and reported in 2015 dollars.ResultsMedicare Part D expenditures on topical steroids between 2011 and 2015 were $2.3 billion. Patients' out-of-pocket spending for topical steroids over the same period was $333.7 million. The total annual spending increased from $237.6 million to $775.9 million, an increase of 226.5%. Patients' annual out-of-pocket spending increased from $41.4 million to $101.8 million, an increase of 145.9%. The total number of prescriptions were 7.7 million in 2011 and 10.6 million in 2015, an increase of 37.0%. Generic medication costs accounted for 97.8% of the total spending during this time period. The potential health care savings and out-of-pocket patient savings from substitution of the cheapest topical steroid within the corresponding potency class were $944.8 million and $66.6 million, respectively.Conclusions and relevanceMost topical steroids prescribed were generic drugs. There has been a sharp increase in Medicare and out-of-pocket spending on topical steroids that is driven by higher costs for generics. Use of clinical decision support tools to enable substitution of the most affordable generic topical steroid from the corresponding potency class may reduce drug expenditures.

Project description:BackgroundSources of regional variation in spending for prescription drugs under Medicare Part D are poorly understood, and such variation may reflect differences in health status, use of effective treatments, or selection of branded drugs over lower-cost generics.MethodsWe analyzed 2008 Medicare data for 4.7 million beneficiaries for prescription-drug use and expenditures overall and in three drug categories: angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), and selective serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Differences in per capita expenditures across hospital-referral regions (HRRs) were decomposed into annual prescription volume and cost per prescription. The ratio of prescriptions filled as branded drugs to all prescriptions filled was calculated. We adjusted all measures for demographic, socioeconomic, and health-status differences.ResultsMean adjusted per capita pharmaceutical spending ranged from $2,413 in the lowest to $3,008 in the highest quintile of HRRs. Most (75.9%) of that difference was attributable to the cost per prescription ($53 vs. $63). Regional differences in cost per prescription explained 87.5% of expenditure variation for ACE inhibitors and ARBs and 56.3% for statins but only 36.1% for SSRIs and SNRIs. The ratio of branded-drug to total prescriptions, which correlated highly with cost per prescription, ranged across HRRs from 0.24 to 0.45 overall and from 0.24 to 0.55 for ACE inhibitors and ARBs, 0.29 to 0.60 for statins, and 0.15 to 0.51 for SSRIs and SNRIs.ConclusionsRegional variation in Medicare Part D spending results largely from differences in the cost of drugs selected rather than prescription volume. A reduction in branded-drug use in some regions through modification of Part D plan benefits might lower costs without reducing quality of care. (Funded by the National Institute on Aging and others.).

Project description:PURPOSE:To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. DESIGN:Retrospective cross-sectional study. PARTICIPANTS:Eye care providers prescribing medications through Medicare Part D in 2013. METHODS:Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug. Savings from generic or therapeutic drug substitutions were estimated for brand drugs. The potential savings from price negotiation was estimated using drug prices negotiated by the United States Veterans Administration (USVA). MAIN OUTCOME MEASURES:Total cost of brand and generic medications prescribed by eye care providers. RESULTS:Eye care providers accounted for $2.4 billion in total Medicare part D prescription drug costs and generated the highest percentage of brand name medication claims compared with all other providers. Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore, also by total cost for eye care providers compared with all other providers (38% vs. 23% by volume, P < 0.001; 79% vs. 56% by total cost, P < 0.001). The total cost attributable to eye care providers is driven by glaucoma medications, accounting for $1.2 billion (54% of total cost; 72% of total volume). The second costliest category, dry eye medications, was attributable mostly to a single medication, cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, CA), which has no generic alternative, accounting for $371 million (17% of total cost; 4% of total volume). If generic medications were substituted for brand medications when available, $148 million would be saved (7% savings); if generic and therapeutic substitutions were made, $882 million would be saved (42% savings). If Medicare negotiated the prices for ophthalmic medications at USVA rates, $1.09 billion would be saved (53% savings). CONCLUSIONS:Eye care providers prescribe more brand medications by volume than any other provider group. Efforts to reduce prescription expenditures by eye care providers should focus on increasing the use of generic medications, primarily through therapeutic substitutions. Policy changes enabling Medicare to negotiate prescription drug prices could decrease costs to Medicare.

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Medicare part D's impact on antipsychotic drug use and costs among elderly patients without prior drug insurance.

Publications

Medicare part D's impact on antipsychotic drug use and costs among elderly patients without prior drug insurance.

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