The lack of financial assistance to cover the cost of drugs to Medicare beneficiaries (the US government's health insurance program for people aged 65 or over, which currently covers 50 million US citizens) could result in an additional 18,000 patients discontinuing one or more prescriptions for essential drugs a year—a 100% increase—and others to not take their required medications regularly.
These findings, from a study led by Jennifer Polinski from the Brigham and Women's Hospital, in Boston, USA, and published in this week's PLoS Medicine, also show that although the Centers for Medicare and Medicaid Services advised patients to consider switching to generic or low-cost drugs, in reality, lack of financial assistance resulted in a decrease in drug switching.
The authors used data from 663,850 Medicare beneficiaries who made prescription claims in 2006-2007 to examine the impact of government policy on essential medication use: In 2006, the government introduced a prescription drug insurance benefit called Medicare Part D to help patients pay for their drugs although patients had to pay all their drug costs after their drug spending reached an annual threshold ($2830 in 2010). Beneficiaries remained in this so-called coverage gap (3-4 million Medicare Part D beneficiaries reach the coverage gap every year) until their out-of-pocket spending reached a catastrophic coverage spending threshold ($4550 in 2010) but the 2010 US health reforms have mandated a gradual reduction in the amount that eligible patients have to pay for their prescriptions once they reach the threshold (coverage gap).
Although this study did not directly investigate the effect of the coverage gap on patient outcomes, these findings suggest that this blunt cost-containment approach could adversely affect health outcomes through their negative effects on medication use. The authors say: "Blunt cost-containment features such as the coverage gap have an adverse impact on drug utilization that may conceivably affect health outcomes."
They continue: "In contrast to blunt cost-sharing approaches such as the coverage gap feature, more nuanced, clinically informed insurance strategies that specifically promote the use of drugs with high benefit and low cost may hold the most promise for governments and insurers seeking to improve the health of their citizens while reigning in drug costs."
Funding: This work was supported by National Institute on Aging T32 AG000158 (JMP), National Institute of Mental Health U01MH079175-02 (SS), National Heart Lung and Blood Institute K23 HL-090505 (WHS), a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (HAH), and a research grant from CVS Caremark. The sponsors had no role in the design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: JMP is a consultant to Buccaneer Computer Systems and Service, Inc, a contractor for the Centers for Medicare and Medicaid Services. Within the past 5 years, JMP's spouse was employed as an engineer by DePuy Orthopaedics, a subsidiary of Johnson & Johnson, and had Johnson & Johnson stock totaling US$3100 in value. WHS is a consultant to United Healthcare, which has a Part D business, but his consulting is unrelated. WHS has received research funding from CVS Caremark, Aetna, and Express Scripts, which all have Part D business. RJG has worked on grants to the Brigham & Women's Hospital, his employer, from Astra Zeneca and Novartis related to the design, statistical monitoring, and analysis of clinical trials in the setting of cardiovascular drugs. RJG also signed a consulting agreement to give a one-time Grand Rounds talk on comparative effectiveness research methods at Merck. JNL was an employee of CVS Caremark at the time of the study. SS is a paid member of the Scientific Advisory Board of HealthCore and a consultant to World Health Information Science Consultants, LLC. SS is Principal Investigator of the Brigham and Women's Hospital DEcIDE Center on Comparative Effectiveness Research funded by AHRQ and the DEcIDE Methods Center. Within the past 5 years, SS was funded by an investigator-initiated grant from Pfizer, which has ended. Opinions expressed here are only those of the authors and not necessarily those of the agencies.
Citation: Polinski JM, Shrank WH, Huskamp HA, Glynn RJ, Liberman JN, et al. (2011) Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap. PLoS Med 8(8): e1001075. doi:10.1371/journal.pmed.1001075
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