Medicare Part D Research and Policy Highlights, 2012: Impact and Insights

Abstract

Background In the 6 years since the implementation of Medicare Part D in the United States, the program has been reported to improve quality, offer better beneficiary protections, and lower drug costs. Objective The purpose of this article was to highlight the latest key peer-reviewed research findings on Medicare Part D and major public policy initiatives for Part D for 2012. Methods PubMed was searched for studies on Medicare Part D published in 2011 in biomedical/scientific, peer-reviewed, English-language journals. For the policy update, sources included the Federal Register, the Medicare Prescription Drug Benefit Manual, the 2012 Final Call Letter, and guidance from the Centers for Medicare and Medicaid Services. Results Medicare Part D has been associated with increased medication utilization, reduced out-of-pocket expenditures, and an overall decrease in cost-related non-adherence and nonpersistence. Its impact on reduction in non-drug utilization of health services has been more apparent after the transition year in 2006 and among subsets of Medicare beneficiaries. Recent policy changes promise to make Part D more user-friendly, simplify choice, and offer greater protection to beneficiaries. The coverage gap will phase out by 2020. Both the quality rating system for prescription drug plans and medication therapy management programs were enhanced. Conclusions Although Part D was designed to improve drug benefits, improvements may be needed in plan selection and simplification, quality assessment (especially with regard to long-term impact and health outcomes), evidence-based improvements in medication therapy management, and disparities among priority subpopulations. Medicare Parts A, B, and D could be coordinated to offset costs by increasing medication expenses and decreasing expenses for nonprescription medical services, thereby improving the overall cost-effectiveness of the Medicare program.

Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly

“…For our impact evaluation, we used MEPS years from 2002 to 2005 to cover the pre–Part D period, whereas data from 2007 to 2010 covered the post–Part D period. We excluded the transitional year of 2006 from the post–Part D period to avoid the likelihood of underestimating the effects of Part D (Afendulis et al, 2011; Lau & Stubbings, 2012). We tested this in a sensitivity analysis.…”

“…Dually eligible beneficiaries and those receiving Supplemental Security Income were automatically signed up for the LIS (Kaiser Family Foundation, 2010). Part D introduction has increased medication use, reduced out-of-pocket expenditure and rates of cost-related nonadherence (Briesacher et al, 2011;Kennedy, Maciejewski, Liu, & Blodgett, 2011;Lau & Stubbings, 2012), and improved medication adherence in patients with hypertension, hyperlipidemias, and diabetes (Zhang et al, 2010), presumably leading to a fall in hospitalization rates (Afendulis, He, Zaslavsky, & Chernew, 2011). Early evaluations of MTM programs in 2010 also showed improvements in medication adherence, especially among clinically complex patients (Perlroth et al, 2013).…”

“…Medicare Part D was implemented in 2006 to expand seniors’ access to prescription drugs by reducing their out-of-pocket burden and to improve the quality of medication use through medication therapy management (MTM) services (Centers for Medicare & Medicaid Services [CMS], 2010; Lau & Stubbings, 2012). Part D further supported low-income seniors, among whom racial/ethnic minorities are overrepresented, by establishing a low-income subsidy (LIS).…”

Variation in Medication Therapy Management Delivery: Implications for Health Care Policy

“…edicare Part D has been in existence for 12 years, and while considered successful in improving access to medications, 1 one component, medication therapy management (MTM), is underused among eligible beneficiaries, and its outcomes are variable. [2][3][4] MTM is defined broadly as "a service or group of services provided by pharmacists to optimize therapeutic outcomes for individual patients" and consists of a medication therapy review, which can be a comprehensive medication review (CMR) or a targeted medication review (TMR) 5 ; provision of a personal medication record and medication-related action plan to the patient; intervention/referral to resolve identified medication-related problems; and documentation and follow-up.…”

Effect of Multiple Pharmacy Use on Medication Adherence and Drug–Drug Interactions in Older Adults with Medicare Part D

“…8,9 Furthermore, pharmacists can improve adherence by issuing refill reminders, using motivational interviewing techniques and promoting medication therapy management. 10,11 Pharmacists may also improve drug safety by avoiding dispensing of drugs causing potential drug-drug interactions (DDIs) by close monitoring of data on prescriptions filled. 12 Using a nationally representative sample of Medicare Part D enrollees, the extent of multiple pharmacy use and its association with medication adherence and potential DDIs in older adults was examined.…”