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Medicare Part D and Quality of Prescription Medication Use in Older Adults

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Abstract

In 2006, the US Centers for Medicare and Medicaid Services implemented Medicare Part D to provide outpatient prescription drug insurance to disabled and older adults. In creating Part D, a key provision to address quality included medication therapy management (MTM) programmes designed to increase proper and safe use of medications among targeted Part D beneficiaries. A preponderance of evidence shows that Part D has increased medication affordability and accessibility; however, what remains less clear is whether it has improved the quality of medication use and optimized health outcomes. Now in its sixth year, Part D is undergoing its first major revision, with the gradual elimination of the coverage gap by 2020. Therefore, now is a good time to review the accumulated evidence on the impact of Part D and MTM programmes on the quality of medication use to help inform future policy decisions and research directions.

In this review, we found that Part D’s net effect on quality of medication use has mainly been positive. Cost-related medication nonadherence improved moderately and there were fewer than expected treatment interruptions. However, vulnerable subgroups, such as sicker and dual-eligible beneficiaries, experienced lags in improvement. Beneficiaries who entered the coverage gap consistently experienced interruptions and displayed worsening medication adherence after entering the gap, with generic-only gap drug coverage offering limited benefit. Such findings can serve as baseline information as the coverage gap phases out.

Limited availability of data is the greatest barrier to research into Part D. Part D’s overall effect on health outcomes and adverse medical events, such as hospitalizations, is inconclusive because of inadequate evidence to date. Similarly, no evaluation of quality of medication use is available with respect to utilization management strategies and MTM programmes delivered under Part D.

Future research will need to further examine the added value of Part D and address whether Part D optimizes health outcomes in the Medicare population. As the current economic recession increases the pressure to cut costs, the effect of future spending restrictions, such as restrictions on coverage subsidies, will also be of special concern.

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Acknowledgements

There was no funding source for this study. During the preparation of this manuscript, Drs Lau and Briesacher were supported by Research Scientist Development Awards from the National Institute on Aging (K01AG027295 and K01AG031836, respectively). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.

All authors declare that no potential conflicts of interests exist, including financial interests or affiliations relevant to the subject of this review.

The authors would like to acknowledge the assistance of Sean McClellan in identifying suitable papers for this manuscript.

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Authors and Affiliations

  1. College of Pharmacy, Department of Pharmacy Administration, University of Illinois at Chicago, 833 S. Wood Street (m/c 871), Chicago, IL, 60612, USA

    Denys T. Lau (Associate Professor)

  2. Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Becky A. Briesacher

  3. Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA

    Daniel R. Touchette & JoAnn Stubbings

  4. The National Committee for Quality Assurance, Washington, DC, USA

    Judy H. Ng

  5. Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA

    Judy H. Ng

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  1. Denys T. Lau
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  2. Becky A. Briesacher
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  3. Daniel R. Touchette
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  4. JoAnn Stubbings
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  5. Judy H. Ng
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Correspondence to Denys T. Lau.

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Lau, D.T., Briesacher, B.A., Touchette, D.R. et al. Medicare Part D and Quality of Prescription Medication Use in Older Adults. Drugs Aging 28, 797–807 (2011). https://doi.org/10.2165/11595250-000000000-00000

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