Medicare’s Part D Drug Benefit At 10 Years: Firmly Established But Still Evolving

Hoadley, John F.; Cubanski, Juliette; Neuman, Patricia

doi:10.1377/hlthaff.2015.0927

Cited by 27 publications

(30 citation statements)

References 2 publications

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“…This information is important to a variety of stakeholders in both the public and private sector, including local, state and federal public health and policy officials and pharmacy retailers, interested in better understanding the role of pharmacies in improving access and adherence to prescription medications. Although policy efforts—such as Medicare Part D—have focused on ensuring the affordability of prescription medications [ 18 ], non-adherence, which varies across localities [ 5 , 6 ], persists as important public health problem in the U.S. [ 19 ], suggesting access barriers, including pharmacy accessibility and the provision of pharmacy accommodations associated with access to prescription medications, are also important to consider.…”

Section: Discussionmentioning

confidence: 99%

The availability of pharmacies in the United States: 2007–2015

et al. 2017

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ImportanceDespite their increasingly important role in health care delivery, little is known about the availability, and characteristics, of community pharmacies in the United States.Objectives(1) To examine trends in the availability of community pharmacies and pharmacy characteristics (24-hour, drive-up, home delivery, e-prescribing, and multilingual staffing) associated with access to prescription medications in the U.S. between 2007 and 2015; and (2) to determine whether and how these patterns varied by pharmacy type (retail chains, independents, mass retailers, food stores, government and clinic-based) and across counties.MethodsRetrospective analysis using annual data from the National Council for Prescription Drug Programs. Pharmacy locations were mapped and linked to the several publically-available data to derive information on county-level population demographics, including annual estimates of total population, percent of population that is non-English speaking, percent with an ambulatory disability and percent aged ≥65 years. The key outcomes were availability of pharmacies (total number and per-capita) and pharmacy characteristics overall, by pharmacy type, and across counties.ResultsThe number of community pharmacies increased by 6.3% from 63,752 (2007) to 67,753 (2015). Retail chain and independent pharmacies persistently accounted for 40% and 35% of all pharmacies, respectively, while the remainder were comprised of mass retailer (12%), food store, (10%), clinic-based (3%) or government (<1%) pharmacies. With the exception of e-prescribing, there was no substantial change in pharmacy characteristics over time. While the number of pharmacies per 10,000 people (2.11) did not change between 2007 and 2015 at the national-level, it varied substantially across counties ranging from 0 to 13.6 per-capita in 2015. We also found that the majority of pharmacies do not offer accommodations that facilitate access to prescription medications, including home-delivery, with considerable variation by pharmacy type and across counties. For example, the provision of home-delivery services ranged from less than <1% of mass retailers to 67% of independent stores and was not associated with county demographics, including ambulatory disability population and percent of the population aged ≥65 years.ConclusionsDespite modest growth of pharmacies in the U.S., the availability of pharmacies, and pharmacy characteristics associated with access to prescription medications, vary substantially across local areas. Policy efforts aimed at improving access to prescription medications should ensure the availability of pharmacies and their accommodations align with local population needs.

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Section: Discussionmentioning

confidence: 99%

The availability of pharmacies in the United States: 2007–2015

et al. 2017

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“…In general, higher pharmacy cost sharing is associated with the use of fewer medications especially among older adults (Harris, Stergachis, & Reid, 1990; Smith, 1993; Lillard, Rogowski, & Kington, 1999; Joyce, Escarce, Solomon, & Goldman, 2002; Goldman et al, 2004; Goldman, Joyce, & Zheng, 2007; Karaca-Mandic, Swenson, Abraham, & Kane, 2012a). While Medicare Part D has increased beneficiaries’ access to prescription drugs (Licthenberg & Sun, 2007), there are significant differences in drug plans’ cost-sharing (Karaca-Mandic et al, 2012a), tiered formulary structures (Hoadley, Hargrave, Merrell, Cubanski, & Neuman, 2007), number of covered drugs (Hoadley, Hargrave, Merrell, Cubanski, & Neuman, 2008), and provision of gap coverage (Hoadley, Cubanski, Hargrave, Summer, & Neuman, 2009). Concerns have also been raised about the adverse effect of the donut hole on medication use (Zhang, Donohue, Newhouse, & Lave, 2009; Raebel, Delate, Ellis, & Bayliss, 2008; Fung et al, 2010; Hsu et al, 2008; Gu, Zeng, Patel, & Tripoli, 2010; Hales & George, 2010).…”

Section: Introductionmentioning

confidence: 99%

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Lin

Karaca‐Mandic

McCullough

et al. 2014

Women's Health Issues

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Background For women living with osteoporosis, high out-of-pocket drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis out-of-pocket medication costs and female Medicare beneficiaries’ initiation of osteoporosis drug therapy. Methods We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in standalone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the out-of-pocket costs and initiation of oral osteoporosis drug therapy during the year of diagnosis. Findings Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries’ out-of-pocket costs were not associated with the initiation of drug therapy for osteoporosis. However, there were statistically significant racial disparities in beneficiaries’ initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points respectively more likely to initiate drug therapy than whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries. Conclusions Access barriers for drug therapy initiation may be driven by factors other than patients’ out-of-pocket costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies.

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“…This is likely driven in part by continuous increases in the cost of health care coverage and increases in the out-of-pocket costs for seniors. 28 …”

Section: Discussionmentioning

confidence: 99%

Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data

Pauly

Talbert

Brown

2016

JMCP

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BACKGROUND Administrative claims data are used for a wide variety of research and quality assurance purposes; however, they are prone to medication exposure misclassification if medications are purchased without using an insurance benefit. Low-cost generic drug programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. LCGP medications are often purchased out of pocket; thus, a pharmacy claim may never be submitted, and the exposure may go unobserved in claims data. As heavy users of medications, Medicare beneficiaries have much to gain from the affordable medications offered through LCGPs. This use may put them at increased risk of exposure misclassification in claims data. Many high-risk medications (HRMs) and medications tracked for adherence and utilization quality metrics are available through LCGPs, and exposure misclassification of these medications may impact the quality assurance efforts reliant on administrative claims data. Presently, there is little information regarding the use of these programs among a geriatric population. OBJECTIVES To (a) quantify the prevalence of LCGP users in a nationally representative population of Medicare beneficiaries; (b) compare clinical and demographic characteristics of LCGP users and nonusers; (c) assess determinants of LCGP use and medications acquired through these programs; and (d) analyze patterns of LCGP use during the years 2007-2012. METHODS This study relied on data from the Medical Expenditure Panel Survey (MEPS) from 2007 to 2012. The first 3 objectives were completed with a cohort of individuals in the most recent MEPS panel, while the fourth objective was completed with a separate cohort composed of individuals who participated in MEPS from 2007 to 2012. Inclusion in either study cohort required that individuals were Medicare beneficiaries aged 65 years or greater, used at least 1 prescription drug during their 2-year panel period, and participated in all 5 rounds of data collection during their panel period. MEPS captures medication utilization by surveying individuals on current and previous medication use and verifies this information at the pharmacy level, so prescription fills can be observed irrespective of payment by an insurer or a filed claim. Pharmaceutical utilization was assessed at the individual level for each year of the study period, and LCGP use was recorded as a binary variable for each individual. An LCGP medication fill was identified if the total cost of the drug was paid out of pocket and matched the cost of medications listed on LCGP formularies available from major pharmacy retailers during these years. Cohort demographics and characteristics of interest included age, gender, race, employment status, marital status, family income level, education level, residence in a metropolitan statistical area, geographic region, prescription drug coverage, Medicare type, comorbidities, number of unique medications used, and number of medication fills. Comparison...

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Medicare’s Part D Drug Benefit At 10 Years: Firmly Established But Still Evolving

Cited by 27 publications

References 2 publications

The availability of pharmacies in the United States: 2007–2015

The availability of pharmacies in the United States: 2007–2015

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data

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