Effects of reaching the drug benefit threshold on medicare members? Healthcare utilization during the first year of medicare part D

Medical Care

Volumn 46, Issue 10, 2008, Pages 1116-1122

  Raebel, Marsha A ^a,b   Delate, Thomas ^a,b   Ellis, Jennifer L ^a   Bayliss, Elizabeth A ^a,b  

^a KAISER PERMANENTE   (United States)

^b UNIVERSITY OF COLORADO   (United States)

Author keywords

Coverage gap; Healthcare utilization; Insurance; Medicare Part D; Pharmaceutical services

Indexed keywords

AGED; ARTICLE; CONTROLLED STUDY; FEMALE; HEALTH CARE UTILIZATION; HUMAN; HUMAN EXPERIMENT; MALE; MEDICARE; NORMAL HUMAN; PATIENT COMPLIANCE; PRIMARY MEDICAL CARE; AGE; AMBULATORY CARE; CHRONIC DISEASE; COMORBIDITY; DRUG USE; ECONOMICS; EMERGENCY HEALTH SERVICE; FEE; HEALTH MAINTENANCE ORGANIZATION; HOSPITALIZATION; INSURANCE; ORGANIZATION AND MANAGEMENT; POISSON DISTRIBUTION; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

AGE FACTORS; AGED; AGED, 80 AND OVER; CHRONIC DISEASE; COLORADO; COMORBIDITY; DRUG UTILIZATION REVIEW; ELIGIBILITY DETERMINATION; EMERGENCY SERVICE, HOSPITAL; FEMALE; HEALTH MAINTENANCE ORGANIZATIONS; HOSPITALIZATION; HUMANS; INSURANCE COVERAGE; MALE; MEDICARE PART D; OFFICE VISITS; PATIENT COMPLIANCE; POISSON DISTRIBUTION; PRESCRIPTION FEES; UNITED STATES;

EID: 53449093425     PISSN: 00257079     EISSN: None     Source Type: Journal    
DOI: 10.1097/MLR.0b013e318185cddd     Document Type: Article

References (30)

1. Dept. of Health and Human Services., Centers for Medicare & Medicaid Services. Key milestones in CMS programs. October 7, 2004. Available at: http://www.cms.hhs.gov/History/Downloads/CMSProgramKeyMilestones.pdf. Accessed July 7, 2008.
2. Socolar SJ. To preserve and strengthen Medicare. Med Care. 2008;46: 1017-1019.
3. The Henry J Kaiser Foundation. Medicare prescription drug coverage among Medicare beneficiaries. Available at http://www.kff.org/medicare. Accessed July 7, 2008.
4. The Henry J. Kaiser Family Foundation. The Medicare Prescription Drug Benefit (#7044-04). June, 2006. Available at: www.kff.org. Accessed July 7, 2008.
5. Alternative coverage and enhanced alternative coverage, Center for Medicare Advocacy, Inc. Available at: http://www.medicareadvocacy.org/FAQ-PartD. htm#alternative. Accessed July 7, 2008.
6. Hsu J, Price M, Huang J, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006;354:2349-2359.
7. Bach PB, McClellan MB. The first months of the prescription-drug benefit-a CMS update. N Engl J Med. 2006;354:2312-2314.
8. Cox ER, Jernigan C, Coons SJ, et al. Medicare beneficiaries' management of capped prescription benefits. Med Care. 2001;39:296-301.
9. Cox ER, Henderson RR. Prescription use behavior among Medicare beneficiaries with capped prescription benefits. J Manag Care Pharm. 2002;8:360-364.
10. Tseng CW, Brook RH, Keeler E, et al. Cost-lowering strategies used by Medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage. JAMA. 2004;292:952-960.
11. Piette JD, Heisler M. The relationship between older adults' knowledge of their drug coverage and medication cost problems. J Am Geriatr Soc. 2006;54:91-96.
12. Tamblyn R, Laprise R, Hanley JA, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285:421-429.
13. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmcy data. J Clin Epidemiol. 1992;45:197-203.
14. Clark DO, Von Korff M, Saunders K, et al. A chronic disease score with empirically derived weights. Med Care. 1995;33:783-795.
15. Johnson RE, Hornbrook MC, Nichols GA. Replicating the chronic disease score (CDS) from automated pharmacy data. J Clin Epidemiol. 1994;47:1191-1199.
16. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-cm and ICD-10 administrative data. Med Care. 2005;43:1130-1139.
17. Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived from ICD-9-CM administrative data. Med Care. 2002;40:675-685.
18. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-383.
19. Hamilton RA, Briceland LL. Use of prescription-refill records to assess patient compliance. Am J Hosp Pharm. 1992;49:1691-1696.
20. Hess LM, Raebel MA, Conner DA, et al. Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures. Ann Pharmacother. 2006;40:1280-1288.
21. Schneeweiss S, MacClure M. Use of comorbidity scores for control of confounding in studies using administrative databases. Int J Epidemiol. 2000;29:891-898.
22. Daniel GW, Malone DC. Characteristics of older adults who meet the annual prescription drug expenditure threshold for Medicare medication therapy management programs. J Manag Care Pharm. 2007;13:142-154.
23. Joyce GF, Goldman DP, Karaca-Mandic P, et al. Pharmacy benefit caps and the chronically ill. Health Aff. 2007;27:1333-1344.
24. Neuman P, Strollo MK, Guterman S, et al. Medicare prescription drug benefit progress report: findings from a 2006 national survey of seniors. Health Aff. 2007;26:w630-w643.
25. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162:2269-2276.
26. Gijsen R, Hoeymans N, Schellevis FG, et al. Causes and consequences of comorbidity: a review. JClin Epidemiol. 2001;54:661-674.
27. Oldridge NB, Stump TE, Nothwehr FK, et al. Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle-and older-age adults. J Clin Epidemiol. 2001;54:928-934.
28. Hsu J, Fung V, Price M, et al. Medicare beneficiaries' knowledge of Part D prescription drug program benefits and responses to drug costs. JAMA. 2008;299:1929-1936.
29. Madden JM, Graves AJ, Zhang F, et al. Cost-related medication non- adherence and spending on basic needs following implementation of Medicare Part D. JAMA. 2008;299:1922-1928.
30. Goldman DP, Joyce GF. Medicare Part D: a successful start with room for improvement. JAMA. 2008;299:1954-1955.