Public Health.

Area of Science:

• Gerontology
• Health Economics
• Pharmacoeconomics

Background:

• Examines the relationship between medication and healthcare access and total Medicare costs, including Part B, Part D, and out-of-pocket prescription expenses.
• Focuses on Medicare fee-for-service (FFS) beneficiaries aged 65 and older diagnosed with Alzheimer's disease and related dementias (ADRD).

Purpose of the Study:

• To investigate how access to medications and routine healthcare influences healthcare expenditures among Medicare beneficiaries with ADRD.
• To identify specific cost drivers, such as Part B, Part D, and out-of-pocket expenses, associated with access barriers.

Main Methods:

• Utilized linked data from the Consumer Assessment of Healthcare Providers and Systems surveys (2018, 2019, 2021-2022) and Medicare Beneficiary Summary Files.
• Conducted a cross-sectional analysis using generalized linear models with log-normal and gamma distributions to manage skewed cost data, incorporating survey weights and state fixed effects.
• Assessed medication access via a self-reported measure on the ease of obtaining prescribed medicines over the prior six months.

Main Results:

• Easier access to prescription medications was significantly associated with lower total Medicare costs (coef = -0.08, p = 0.001), Part D costs (coef = -0.20, p = 0.002), and Part D out-of-pocket costs (coef = -0.08, p = 0.019).
• Access to medications did not significantly affect Part B costs, while easier access to routine healthcare appointments correlated with higher Part B costs (coef = 0.183, p = 0.003) and out-of-pocket Part B expenses (coef = 0.223, p = 0.002).
• ADRD FFS patients in socially vulnerable areas had significantly lower Part B costs (coef = -0.78, p = 0.001).

Conclusions:

• Improving access to necessary medications is crucial for managing healthcare costs in ADRD patients.
• While easier medication access lowers prescription drug costs, ensuring access to routine care, including Part B drugs administered in physician offices, is essential for dementia care management.