Understand Medicare Part D’s design and its coverage gap to offer the most affordable prescription drug options for patients.
Medicare Part D has reduced-but not solved-the problem of out-of-pocket pharmacy costs for older adults with diabetes, according to a study published online in Diabetes Care.
“Managed care executives should be interested because diabetes affects approximately 25% of Medicare beneficiaries,” says study author Arlene Smaldone, PhD, CPNP, CDE, associate professor of nursing at at Columbia University School of Nursing. “Our study found that while the Part D benefit has overall reduced out-of-pocket costs for older adults with diabetes, approximately 40% continue to enter or exceed the ‘donut-hole’ period.”
Using data from the Medical Expenditure Panel survey, Smaldone, and colleagues, examined the proportion of out-of-pocket pharmacy costs for Medicare beneficiaries before and after implementation of the Part D benefit and compared them to the proportion of out-of-pocket pharmacy expenditures for those age 50 to 60 years old who were not eligible for the Medicare benefit. The effect of the Medicare Part D benefit over time was statistically modeled using an interrupted time series analysis and the net benefit attributed to the Part D benefit was analyzed using a difference-in-difference approach.
The study found that after implementation of Medicare Part D, the proportion of out-of-pocket pharmacy costs was lower for Medicare beneficiaries (29.2%) compared to the younger comparison group (37.7%).
“Uptake of Medicare Part D benefit was utilized by those who lacked access prior to the benefit: women, blacks and Hispanics and those who had reported problems in getting their medications prior to Part D,” Smaldone, assistant dean, scholarship and research, Columbia University School of Nursing, tells Managed Healthcare Executive.
Additionally, over the period 2006 to 2011, the Part D benefit reduced out of pocket costs for prescription drugs by 19.4%.
The Medicare Part D pharmacy benefit was the first major policy change to Medicare since its inception, according to Smaldone.
“However, the benefit does not fully cover cost of prescription drugs, has a donut-hole period where beneficiaries are responsible for the full cost of their drugs and poses risk of poor medication adherence due to inability to pay these costs,” she says. “While Part D has been previously studied, it has not been well studied in older adults with diabetes. We were interested in how the benefit has worked for older adults with diabetes and the proportion of older adults with diabetes who were vulnerable to the donut hole.”
Based on the study, Smaldone offers four takeaways:
1. The Part D benefit has reduced but not solved the problem of out-of-pocket costs for older adults with diabetes.
2. Entry into the donut-hole period makes elders vulnerable to poor medication adherence through inability to pay full cost of medications thereby posing risks to health.
3. While efforts are currently under way through the Affordable Care Act to close the donut-hole gap, full achievement of these efforts and its effects on out-of-pocket costs for older adults with diabetes remain uncertain.
4. To reduce the risks of cost-related medication nonadherence, healthcare providers must understand Medicare Part D’s design and its coverage gap to offer the most affordable prescription drug options for their patients.