Implementation of Medicare Part D and Nondrug Medical Spending for Elderly Adults

With Limited Prior Drug CoverageHaiden Huskamp PhD, J. Michael McWilliams MD, Alan Zaslavsky

• Jon Wilson• Mercer PharmD Candidate• C/O 2012

Medicare Part D

• Introduced in January 2006

• Increased medication use

• Reduced out of pocket costs

• Adherence to essential medications for elderly persons

Before Part D

• Limits on drug benefits for elderly adults were associated with greater use of acute care

Objective

• To assess changes in nondrug medical spending following the introduction of Part D for Medicare beneficiaries with limited prior drug coverage.

• Study cohort(2004-2007) and control cohort(2002-2005)****To assess changes in spending when not affected by Part D

Study Cohort

• Longitudinal survey data and Medicare claims from 2004-2007.– Data before and after implementation of Part D– 2538 patients with generous drug coverage before

2006– 3463 patients with limited drug coverage before

2006

Control Cohort

• Survey Participants from 2002-2005– 2537 with generous drug coverage– 3451 with limited drug coverage

Study Population

• Inclusion– Enrolled in traditional Medicare at the beginning of

2002/2004

• Exclusion– Patients who became eligible for Medicare before age 65– Military Veterans who received care from VA

Criteria the same for both Study and Control Cohorts

Nondrug Medical Spending

• Assessed quarterly • Inpatient and skilled nursing facility

institutional services cover by Part A• Physician and ancillary services covered by

Part B• Since Part B covers inpatient and outpatient

physician services, outpatient data was analyzed to distinguish differences

Results

• Nondrug medical spending after Part D was 3.9% lower for participants with limited prior drug coverage than those with generous coverage.

• -$306/quarterly between observed and expected

Results

Results

Control Cohort Results

• Differences in nondrug medical spending between participants with limited vs. generous drug coverage in 2002 were similar before and after January 1, 2004.

Control Cohort Results

Conclusion

• Implementation of Part D was associated with differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.

Comment

• Increased medication use and adherence achieved through Part D have been associated with decreased spending for nondrug medical care.

• Drug coverage gains may have also reduced early complications of acute conditions.

Level of Evidence