Journal of General Internal Medicine

, Volume 25, Issue 1, pp 10–17

Prescription Coverage, Use and Spending Before and After Part D Implementation: A National Longitudinal Panel Study

  • Dana Gelb Safran
  • Michelle Kitchman Strollo
  • Stuart Guterman
  • Angela Li
  • William H. Rogers
  • Patricia Neuman
Original Article

DOI: 10.1007/s11606-009-1134-2

Cite this article as:
Safran, D.G., Strollo, M.K., Guterman, S. et al. J GEN INTERN MED (2010) 25: 10. doi:10.1007/s11606-009-1134-2

Abstract

BACKGROUND

In January 2006, 43 million Medicare beneficiaries became eligible for subsidized prescription coverage (Part D) through Medicare. To date, no longitudinal study has afforded information on beneficiaries’ prescription coverage transitions and corresponding changes in prescription use and spending.

OBJECTIVE

To evaluate changes in Medicare beneficiaries’ prescription coverage, use and spending before and after Part D implementation, including comparison of those who enrolled in Part D with those who did not.

DESIGN, SETTING AND PARTICIPANTS

Longitudinal observational study of non-institutionalized Medicare beneficiaries aged 65 and older (n = 9,573) employing administrative data from the Centers for Medicare and Medicaid Services (CMS) and survey-based data from beneficiaries (2003, 2006). Sampling drew from a 1% national probability sample (2003), oversampling low-income beneficiaries including those dually-enrolled in Medicare and Medicaid.

MEASUREMENTS & MAIN RESULTS

Number and type of prescriptions, monthly out-of-pocket prescription spending, and cost-related non-adherence to prescription regimens. Most respondents who lacked prescription coverage in 2003 had acquired it by 2006 (82.6%)—primarily through Part D (63.1%). Part D enrollees who previously lacked coverage or had Medigap coverage appear particularly advantaged by Part D, as evidenced by significantly increased prescription use, lower out-of-pocket spending and lower non-adherence. Those with employer-based coverage experienced significantly increased spending. Among those still lacking coverage in 2006, high rates of cost-related non-adherence (31.8%) were reported by the low-income, chronically ill subgroup.

CONCLUSIONS

In its first year, Part D coverage appears to have moderated prescription spending and cost-related burden for those who previously had meager benefits or none. Increased spending among those with employer-based coverage may reflect a narrowing of those benefits over this period. Evidence of foregone care among low-income, chronically ill seniors who still lack prescription coverage highlights the importance of targeted outreach to this group for Part D’s low-income subsidy program.

KEY WORDS

Medicare Part Dmedication adherenceprescription drug use

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Dana Gelb Safran
    • 1
    • 2
    • 3
  • Michelle Kitchman Strollo
    • 5
  • Stuart Guterman
    • 4
  • Angela Li
    • 1
    • 3
  • William H. Rogers
    • 1
    • 2
  • Patricia Neuman
    • 5
  1. 1.The Health Institute, Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonUSA
  2. 2.Department of MedicineTufts University School of MedicineBostonMAUSA
  3. 3.Blue Cross Blue Shield of MassachusettsBostonMAUSA
  4. 4.Commonwealth FundNew YorkUSA
  5. 5.The Henry J. Kaiser Family FoundationMenlo ParkUSA