Quality Implications of Medicare Part D: Impact on Beneficiaries

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Quality Implications of Medicare Part D Impact
on Beneficiaries

• Bruce Stuart, PhD
• Director, Peter Lamy Center on Drug Therapy and
  Aging
• University of Maryland Baltimore

The Commonwealth Fund Quality Improvement
Colloquium Washington DC, June 30, 2004
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Quality Levers in the MMA

• On the positive side.
• Improved access to pharmaceuticals
• Electronic prescribing (eventually)
• Chronic care demonstrations
• Medication Therapy Management provisions
• On the negative side
• Stand-alone risk-bearing drug plans
• Formularies
• Benefit gaps

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Assessing the Impact of Gaps in the Part D
Standard Benefit

• Statutory provisions of the MMA
• Modeling the relationship between drug spending
  levels and periods without coverage
• Assessing the persistency of spending over
  several years
• Assessing beneficiary behavioral response to
  benefit gaps

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Coverage Gaps under the Part D Standard Benefit
in 2006
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Preliminary Study Findings

• The Commonwealth Fund
• Riding the Rollercoaster forecasts spending to
  2006-2008 for beneficiaries most likely to enroll
  in Part D
• Robert Wood Johnson Foundation HCFO Initiative
• Benefit Gaps Bite estimates the impact of gap
  duration on drug spending for beneficiaries with
  common chronic conditions.

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Estimated Quarterly Out-of-Pocket Drug Spending
for Potential Part D Enrollees,
2006-2008(beneficiaries with income gt 150 fpl
and without stable Rx benefits from Medicaid,
employers, or public programs)
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Mean Estimated Quarterly Out-of-Pocket Drug
Spending for High Spenders, 2006-2008(potential
enrollees with estimated spending in 2006
gt2,250)
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Mean Estimated Quarterly Out-of-Pocket Drug
Spending for Catastrophic Spenders, 2006-2008
(potential enrollees with estimated spending in
2006 gt5,100)
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Benefit Gaps and Drug Spending for a 3-Year
Cohort of Community-Dwelling Medicare
Beneficiaries, 1998-2000
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Estimated Impact of Drug Benefit Gaps on
Beneficiaries with Selected Diseases, 1998-2000
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Conclusions

• Because drug spending is highly persistent even
  for high spenders, once beneficiaries are on the
  Part D benefit rollercoaster they will find it
  difficult to get off.
• The Part D donut hole will have a significant
  negative effect on drug use and the greatest
  impact will be on beneficiaries with
  medication-sensitive chronic conditions.