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Utilization and costs of cardiovascular disease medications in dialysis patients in Medicare Part D
Diane L Frankenfield1, Eric D Weinhandl, Christopher A Powers
1Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation, Baltimore, MD 21244, USA. diane.frankenfield@cms.hhs.gov
Insights
Cardiovascular disease (CVD) medication use in dialysis patients shows beta-blockers as most common. Out-of-pocket costs were higher for those without the low-income subsidy, despite similar total drug costs.
Area of Science:
- Nephrology
- Cardiology
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a leading cause of death and disability among dialysis patients.
- Limited data exists on the population-level use of CVD medications in this high-risk group.
Purpose of the Study:
- To describe the utilization patterns and costs of cardiovascular disease (CVD) medications among adult dialysis patients in the United States.
- To examine variations in medication use and costs based on demographic characteristics and low-income subsidy status.
Main Methods:
- Retrospective cohort study of adult dialysis patients enrolled in Medicare Parts A, B, and D in 2007.
- Analysis of prescription fills for CVD medications and associated out-of-pocket and total costs.
- Stratification by low-income subsidy status and demographic factors.
Main Results:
- Beta-blockers were the most frequently used CVD medication (64%), followed by renin-angiotensin system inhibitors (52%) and calcium channel blockers (51%).
- Patients receiving the low-income subsidy had higher total medication costs ($124.02/month) compared to those without ($110.32/month).
- Out-of-pocket costs were substantially higher for patients without the low-income subsidy ($49.59/month) versus those with it ($3.44/month).
Conclusions:
- Most Medicare dialysis patients were enrolled in Part D, with a majority receiving the low-income subsidy.
- Significant disparities in out-of-pocket medication costs exist based on subsidy status.
- Further research is needed to understand variations in CVD medication use and costs across patient subgroups.
Background:
Cardiovascular disease (CVD) is a major source of mortality and morbidity in dialysis patients. Population-level descriptions of CVD medication use are lacking in this population.
Study Design:
Retrospective cohort study.
Setting & Participants:
Adult dialysis patients in the United States, alive on December 31, 2006, with Medicare Parts A and B and enrollment in Medicare Part D continuously in 2007.
Predictor:
CVDs and demographic characteristics.
Outcome:
≥1 prescription fill during follow-up (2007).
Measurements:
Average out-of-pocket costs per user per month and average total drug costs per member per month were calculated.
Results:
Of 225,635 dialysis patients who met inclusion criteria during the entry period, 70% (n = 158,702) had continuous Part D coverage during follow-up. Of these, 76% received the low-income subsidy. β-Blockers were the most commonly used CVD medication (64%), followed by renin-angiotensin system inhibitors (52%), calcium channel blockers (51%), lipid-lowering agents (44%), and α-agonists (23%). Use varied by demographics, geographic region, and low-income subsidy status. For CVD medications, mean out-of-pocket costs per user per month were $3.44 and $49.59 and mean total costs per member per month were $124.02 and $110.32 for patients with and without the low-income subsidy, respectively.
Limitations:
Information was available for only filled prescriptions under the Part D benefit; information for clinical contraindications was lacking, information for over-the-counter medications was unavailable, and medication adherence and persistence were not examined.
Conclusions:
Most Medicare dialysis patients in 2007 were enrolled in Part D, and most enrollees received the low-income subsidy. β-Blockers were the most used CVD medication. Total costs of CVD medications were modestly higher for low-income subsidy patients, but out-of-pocket costs were much higher for patients not receiving the subsidy. Further study is warranted to delineate sources of variation in the use and costs of CVD medications across subgroups.
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