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The introduction of Medicare Part D was a mixed blessing for elderly beneficiaries who didn't have drug coverage before.
ABSTRACT:
This study evaluates the effect of Medicare Part D among seniors who previously lacked drug coverage, using time-trend analyses of patient-level dispensing data from three pharmacy chains. Of 114,766 seniors without drug benefits, 55 percent initiated drug insurance under Part D. After the penalty-free Part D enrollment period, use of statins, clopidogrel, and proton pump inhibitors stabilized at levels ranging from 11 percent to 37 percent above the trend that would have been expected if Part D had not been implemented. Patients reaching the Part D coverage gap (12 percent) experienced a decrease in essential medication use ranging from 5.7 percentage points per month for warfarin to 6.3 percentage points for statins. [Health Affairs 28, no. 2 (2009): w305-w316 (published online 3 February 2009; 10.1377/hlthaff.28.2.w305)]
BEFORE IMPLEMENTATION of Medicare's Part D prescription drug benefit, one-third of Medicare's fortythree milUon elderly beneficiaries had no prescription drug coverage.1 Surveys of seniors without such coverage indicated that they ten restricted their medication use because of high costs.2 The Medicare prescription drug benefit was estabUshed to assist seniors by covering prescription drugs for all who voluntarily enroll. As of June 2006, 22.5 million seniors had enrolled in a Medicare Part D plan, 15.8 million had another source of drug coverage, and approximately 4.4 million (10 percent) still had no coverage.3
To control costs, legislators relied on costsharing requirements and formulary management by private prescription drug plans. Beneficiaries enrolling in Part D were required to pay monthly premiums, a deductible, and differing copayments depending on their absolute drug spending during the year, with exact amounts varying by drug benefit plan and subsidy level.4 One controversial component of the standard Part D benefit is a period of no coverage (the "doughnut hole"). Once total spending on a beneficiary's prescription drugs reached $2,250 in 2006, he or she was required to pay the entire cost of medications until reaching $3,600 in out-of-pocket spending, at which point coverage resumed.5 In the first months of Part D, 1,429 stand-alone drug plans, regulated and overseen by the Centers for Medicare and Medicaid Services (CMS), were offered to seniors.6 These plans offered a wide variety...