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The study is the first to use a large, national claims dataset to examinethe effect of Part D enrollment on drug utilization and out-of-pocket costsfor enrollees with type 2 diabetes. In addition to exploring utilization andcost data, the study also shows that the majority of enrollees with type 2diabetes that reached the coverage gap, or "donut hole," threshold in 2006 didso by August, but this experience did not precipitate a drop in the number ofprescriptions filled after that point.
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Medicare Part D ushered in sweeping changes to the Medicare program, withthe intent of creating affordable access to drug coverage for all seniors,thus improving their ability to purchase necessary prescription drugs andbetter manage their health. While recent public opinion research has shownhigh consumer satisfaction with Part D, little quantitative research has beenpublished to test the actual effects of Part D on seniors' out-of-pocket costsand access to drugs.
The new Avalere study pulls back the curtain on the first two years of thedrug benefit to see if Part D is meeting its stated policy goals with respectto diabetes. Its findings bode well for people with type 2 diabetes. First,most drugs used to treat diabetes and its two most common co-occurringconditions -- hypertension and dyslipidemia -- are widely covered by Part Dhealth plans, at rates of 85-88 percent, and on tiers 1 and 2 of planformularies which are associated with the lowest co-payments. By comparison,previous Avalere analysis shows that Part D formularies include an average of75 percent of antipsychotic drugs and 88 percent of antidepressants, classesof drugs designated by the government as "protected."
Access is also measured via utilization, or how many prescriptions peopletake, and how much they are spending for those drugs. On both counts,Avalere's report points to improvements for Medicare Part D enrollees withtype 2 diabetes. Out-of-pocket diabetes drug costs per prescription were 35percent lower for standalone prescription drug plan (PDP) enrollees and 25percent lower for Medicare Advantage prescription drug (MA-PD) plan enrollees,as compared to fellow Medicare beneficiaries who chose not to enroll in PartD. PDP enrollees were taking 11.2 percent more prescriptions and MA-PDenrollees 6.2 percent more prescriptions than before they had Part D coverage.
"Part D is meeting its goals of increasing access to, and affordabilityof, drugs to Medicare beneficiaries," said Valerie Barton, vice president ofAvalere Health and co-author of the study.
A unique aspect of Part D is the coverage gap, or donut hole. To date,there has been much speculation on whether the coverage gap would be ahindrance to continuity of care and access to medications. Avalere found that43 percent of non-Medicaid beneficiaries with type 2 diabetes enrolled in PDPsand 33 percent enrolled in MA-PDs reached the threshold by the end of 2006.In 2006, the majority who reached that threshold did so by August. Buthitting the gap did not correlate with reduced use of prescription drugs, andin fact, the study showed no reduction in the number of prescriptions filledby patients with diabetes.
"Knowing when people with diabetes may hit the coverage gap is importantfor physicians who can look for signs of non-compliance, and for individualswho can use this data for financial planning purposes," said Barton. "The lackof change in the number of prescription drugs used invites more research onwhether patients with type 2 diabetes tend to enroll in Part D plans thatoffered gap coverage, the financial sensitivity of patients with chronicillness, and generic switching patterns
