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Effects of Medicare Part D coverage gap on medication adherence
Yuting Zhang1, Seo Hyon Baik, Judith R Lave
1Department of Health Policy and Management, University of Pittsburgh, 130 De Soto St, Crabtree Hall A664, Pittsburgh, PA 15261, USA. ytzhang@pitt.edu
The American Journal of Managed Care
|July 13, 2013
Summary
Medicare Part D beneficiaries reduced prescription use, especially brand-name drugs, when entering the coverage gap. However, medication adherence for essential heart failure and diabetes drugs remained largely unaffected.
Area of Science:
- Health Economics
- Pharmaceutical Policy
- Geriatric Medicine
Background:
- The Medicare Part D program introduced a coverage gap, also known as the
- donut hole,
- which can affect prescription drug costs for beneficiaries.
- Understanding the impact of this coverage gap on medication use and adherence is crucial for evaluating healthcare policy.
Purpose of the Study:
- To assess how the Medicare Part D coverage gap influences pharmacy utilization among Medicare beneficiaries.
- To determine the effect of the coverage gap on medication adherence in patients with heart failure and/or diabetes.
Main Methods:
- Utilized a pre-post design with a comparison group and propensity score weighting.
- Analyzed a 5% random sample of elderly Medicare beneficiaries from 2007.
- Compared outcomes for beneficiaries with full coverage in the gap versus those with no or generic-only coverage.
Main Results:
- Beneficiaries without coverage in the gap decreased prescription fills by 16.0%; those with generic-only coverage reduced fills by 10.8%.
- Reductions were primarily in the use of brand-name medications.
- Adherence to heart failure medications decreased by 3.6%, and adherence to antidiabetic medications decreased by 10.3%.
Conclusions:
- Medicare beneficiaries reduced overall medication use, particularly brand-name drugs, upon entering the Part D coverage gap.
- Despite financial burdens, the coverage gap did not lead to substantial reductions in adherence for essential diabetes and heart failure medications.
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