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Part D coverage gap and adherence to diabetes medications
Qian Gu1, Feng Zeng, Bimal V Patel
1School of Policy, Planning, and Development, University of Southern California, Los Angeles, CA, USA.
The American Journal of Managed Care
|February 26, 2011
Summary
The Medicare Part D coverage gap significantly reduces adherence to diabetes medications. Maintaining brand-name drug coverage in the donut hole is crucial for patient adherence.
Area of Science:
- Health Services Research
- Pharmaceutical Policy
- Diabetes Management
Background:
- The Medicare Part D program aims to provide prescription drug coverage.
- The coverage gap, or 'donut hole,' can significantly increase out-of-pocket costs for beneficiaries.
- Understanding the impact of the coverage gap on medication adherence is vital for patient health outcomes.
Purpose of the Study:
- To evaluate the effect of the Medicare Part D coverage gap on adherence to diabetes medications.
- To assess how different levels of coverage within the donut hole influence adherence.
Main Methods:
- Retrospective cohort analysis of pharmacy claims data.
- Included 12,881 Medicare Part D beneficiaries with diabetes entering the coverage gap in 2008.
- Utilized a difference-in-difference model to analyze adherence based on coverage levels (no coverage, generic only, generic and brand-name).
Main Results:
- Beneficiaries with no coverage or generic-only coverage in the donut hole were significantly less likely to be adherent to diabetes medications.
- Odds ratios for non-adherence were 0.617 (no coverage) and 0.702 (generic only) compared to full coverage.
- The copayment for diabetes medications increased substantially for those with no or generic-only coverage.
Conclusions:
- The Medicare Part D coverage gap negatively impacts medication adherence for diabetic beneficiaries.
- Brand-name drug coverage within the donut hole is critical for maintaining adherence to diabetes medications.
- Policy interventions addressing the coverage gap may improve medication adherence and health outcomes.
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