How do seniors respond to 100% cost-sharing for prescription drugs? Quality of the evidence underlying opinions about the medicare part D coverage gap

Journal of Managed Care Pharmacy

Volumn 17, Issue 5, 2011, Pages 382-392

  Fairman, Kathleen A ^a   Curtiss, Frederic R ^a  

^a Journal of Managed Care Pharmacy   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANGIOTENSIN RECEPTOR ANTAGONIST; ANTIDEPRESSANT AGENT; ANTIDIABETIC AGENT; ANTIHYPERTENSIVE AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BETA1A INTERFERON; BISPHOSPHONIC ACID DERIVATIVE; CENTRAL NERVOUS SYSTEM AGENTS; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT; GABAPENTIN; GENERIC DRUG; GLATIRAMER; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; METFORMIN; NEUROLEPTIC AGENT; NON PRESCRIPTION DRUG; OMEPRAZOLE; ORAL ANTIDIABETIC AGENT; PRESCRIPTION DRUG; PROTON PUMP INHIBITOR;

BEHAVIOR; COST BENEFIT ANALYSIS; COST CONTROL; COST EFFECTIVENESS ANALYSIS; DATA BASE; DRUG COST; EDITORIAL; GERIATRIC CARE; HEALTH CARE UTILIZATION; HEALTH INSURANCE; HEALTH SURVEY; HUMAN; MEDICARE; MULTIPLE SCLEROSIS; NON INSULIN DEPENDENT DIABETES MELLITUS; OSTEOPOROSIS; PHARMACY; PRESCRIPTION; TREATMENT REFUSAL; AGE; AGING; ATTITUDE TO HEALTH; COST; ECONOMICS; EVIDENCE BASED MEDICINE; HEALTH CARE DELIVERY; METHODOLOGY; PATIENT COMPLIANCE; PSYCHOLOGICAL ASPECT; UNITED STATES;

AGE FACTORS; AGING; COST SAVINGS; COST SHARING; DRUG COSTS; DRUGS, GENERIC; EVIDENCE-BASED MEDICINE; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE, MEDIGAP; INSURANCE, PHARMACEUTICAL SERVICES; MEDICARE PART D; MEDICATION ADHERENCE; PRESCRIPTION DRUGS; RESEARCH DESIGN; UNITED STATES;

EID: 80052519384     PISSN: 10834087     EISSN: None     Source Type: Journal    
DOI: 10.18553/jmcp.2011.17.5.382     Document Type: Editorial

References (54)

1. Anonymous. Medicare's troubling drug gap. NY Times. September 2, 2008. Available at: http://www.nytimes.com/2008/09/02/opinion/02tue2.html?scp=1&sq=&st=nyt. Accessed May 27, 2011.
2. Hoadley J, Hargrave E, Cubanski J, Neuman T. The Medicare Part D coverage gap: costs and consequences in 2007. August 2008. Available at: http://www.kff.org/medicare/7811.cfm. Accessed April 15, 2011.
3. Gu Q, Zeng F, Patel BV, Tripoli LC. Part D coverage gap and adherence to diabetes medications. Am J Manag Care. 2010;16(12):911-18.
4. Hales JW, George S. How the doughnut hole affects prescription fulfillment decisions involving cardiovascular medications for Medicare Part D enrollees. Manag Care. 2010;19(12):36-44. Available at: http://www.managedcaremag.com/archives/1012/1012.peer_doughnut.pdf. Accessed May 16, 2011.
5. Zhang Y, Donohue JM, Newhouse JP, Lave JR. The effects of the coverage gap on drug spending: a closer look at Medicare part D. Health Aff (Millwood). 2009;28(2):w317-25. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859617/pdf/nihms186182.pdf. Accessed May 27, 2011.
6. Pedan A, Lu J, Varasteh LT. Assessment of drug consumption patterns for Medicare Part D patients. Am J Manag Care. 2009;15(5):323-37.
7. Polinski JM, Kilabuk E, Schneeweiss S, Brennan T, Shrank WH. Changes in drug use and out-of-pocket costs associated with Medicare Part D implementation: a systematic review. J Am Geriatr Soc. 2010;58(9):1764-79.
8. Choudhry NK, Shrank WH. Four dollar generics-increased accessibility, impaired quality assurance. N Engl J Med. 2010;363(20):1885-87. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1006189. Accessed May 27, 2011.
9. Savvy Senior. Steps to avoid Medicare D's 'doughnut hole.' Times Herald-Record. April 8, 2011. Available at: http://www.recordonline.com/apps/pbcs.dll/article?AID=/20110408/COMM011101/104080337. Accessed May 27, 2011.
10. Medicare.gov. Five ways to lower your costs during the coverage gap. Available at: http://www.medicare.gov/(X(1)S(y44yop45sv2ymn55ldnt0gqb))/health-and-drugs/bridging-the-coverage-gap.aspx. Accessed May 27, 2011.
11. LIFE Senior Services. Making it through the Medicare Part D coverage gap. Available at: http://www.seniorline.org/seniorline/Making_It_Through_the_Medicare_Part_D_Coverage_Gap.asp?SnID=2. Accessed May 27, 2011.
12. Consumer Reports. Best buy drugs: shopper's guide to prescription drugs-number 3. Available at: http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/money-saving-guides/english/BestPrice-FINAL.pdf. Accessed May 27, 2011.
13. Office of Inspector General. Effect of the Part D coverage gap on Medicare beneficiaries without financial assistance in 2006. March 2009.Available at: http://oig.hhs.gov/oei/reports/oei-05-07-00610.pdf. Accessed May 27, 2011.
14. Cronk A, Humphries TL, Delate T, Clark D, Morris B. Medication strategies used by Medicare beneficiaries who reach the Part D standard drugbenefit threshold. Am J Health-Syst Pharm. 2008;65(1):1062-70.
15. Martin TW, Wilde Mathews A. Walgreen, Caremark in showdown. Wall Street J. June 8, 2010:B1.
16. CanadianPrescriptionSavers.com webpage. Available at: http://www.canadianprescriptionsavers.com/. Accessed May 27, 2011.
17. Mead C. Medicare 'doughnut hole' may induce illegal foreign drug imports. Medill Reports. March 10, 2010. Available at: http://news.medill.northwestern.edu/chicago/news.aspx?id=161187&print=1. Accessed May 27, 2011.
18. Cox E, Tharaldson A, Peterson C, et al. Express Scripts 2007 Drug Trend Report. April 2008. Available at: http://www.express-scripts.com/research/studies/drugtrendreport/2007/. Accessed May 27, 2011.
19. U.S. Food and Drug Administration. Bisphosphonates marketed as alendronate (Fosamax, Fosamax Plus D), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel, Actonel W/Calcium), Tiludronate (Skelid), and zoledronic acid (Reclast, Zometa). October 1, 2007. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150837.htm. Accessed May 27, 2011.
20. Edwards BJ, Gounder M, McKoy JM, et al. Pharmacovigilance and reporting oversight in US FDA fast-track process: bisphosphonates and osteonecrosis of the jaw. Lancet Oncol. 2008;9(12):1166-72.
21. Kolata G. Drug for bones is newly linked to jaw disease. NY Times. June 2, 2006. Available at: http://www.nytimes.com/2006/06/02/health/02jaw.html?_r=2&oref=slogin&oref=slogin. Accessed May 16, 2011.
22. Internal analysis of pharmacy claims database for a single employer in the fourth quarter of 2007; reflects allowed charge after discount rather than average wholesale price.
23. Matchar DB, McCrory DC, Orlando LA, et al. Comparative effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor antagonists (ARBs) for treating essential hypertension. November 2007. Available at: http://www.effectivehealthcare.ahrq.gov/ehc/products/12/45/ACEI_ARBFullReport.pdf. Accessed May 26, 2011.
24. Martin BC, McMillan JA, Kotzan JA. Bias associated with missing outof-plan prescription data for Medicaid recipients. Journal of Research in Pharmaceutical Economics. 1996;7(3):65-77.
25. Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin T, Choodnovskiy I. Effects of Medicaid drug-payment limits on admissions to hospitals and nursing homes. N Engl J Med. 1991;325(15):1072-77. Available at: http://www.nejm.org/doi/full/10.1056/NEJM199110103251505. Accessed May 27, 2011.
26. Tseng CW, Brook RH, Keeler E, Steers WN, Mangione CM. Costlowering strategies used by Medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage. JAMA. 2004;292(8):952-60. Available at: http://jama.ama-assn.org/content/292/8/952.full.pdf+html. Accessed May 27, 2011.
27. Hendricks D. FDA Advisory on Bextra withdrawal, Celebrex and other NSAIDs. May 16, 2005. Available at: http://www.spine-health.com/treatment/pain-medication/fda-advisory-bextra-withdrawal-celebrex-and-othernsaids. Accessed May 27, 2011.
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(16):1929-36. Available at: http://jama.ama-assn.org/content/299/16/1929.long. Accessed May 27, 2011.
29. Raebel MA, Delate T, Ellis JL, Bayliss EA. Effects of reaching the drug benefit threshold on Medicare members' healthcare utilization during the first year of Medicare part D. Med Care. 2008;46(10):1116-22.
30. Hsu J, Price M, Huang J, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006;354(22):2349-59. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMsa054436. Accessed May 27, 2011.
31. Gellad WF, Grenard J, McGlynn EA. A review of barriers to medication adherence: a framework for driving policy options. Rand Health. 2009. Available at: http://www.rand.org/content/dam/rand/pubs/technical_reports/2009/RAND_TR765.pdf. Accessed May 27, 2011.
32. Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients' problems with new medication for chronic conditions. Qual Saf Health Care. 2004;13(3):172-75. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743839/pdf/v013p00172.pdf. Accessed May 27, 2011.
33. Sale JE, Gignac MA, Hawker G, et al. Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: A qualitative study. BMC Musculoskelet Disord. 2011;12(1):92. Available at: http://www.biomedcentral.com/1471-2474/12/92. Accessed May 27, 2011.
34. Fried TR, Tinetti ME, Towle V, O'Leary JR, Iannone L. Effects of benefits and harms on older persons' willingness to take medication for primary cardiovascular prevention. Arch Intern Med. 2011;171(10):923-28.
35. Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008;31(3):213-24. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868342/pdf/nihms200469.pdf. Accessed May 27, 2011.
36. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;16(2):CD000011.
37. O'Riordan M. "A very complex, difficult history for the agency": the FDA on rosiglitazone. theHeart.org. October 5, 2010. Available at: http://www.theheart.org/article/1131047.do. Accessed May 27, 2011.
38. U.S. Food and Drug Administration. FDA drug safety communication: updated risk evaluation and mitigation strategy (REMS) to restrict access to rosiglitazone-containing medicines including Avandia, Avandamet, and Avandaryl. May 18, 2011. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm255005.htm. Accessed May 27, 2011.
39. Hawkes N. Journal withdraws article after complaints from drug manufacturers. BMJ. 2011;342:d2335.
40. U.S. Food and Drug Administration. Sitagliptin (marketed as Januvia and Janumet)-acute pancreatitis. September 25, 2009. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183800.htm. Accessed May 27, 2011.
41. U.S. Food and Drug Administration. Safety. Byetta (exenatide) injections. Warnings and precautions. November 2009. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm194556.htm. Accessed May 27, 2011.
42. Keeler EB. Effects of cost sharing on use of medical services and health. J Med Pract Manage. 1992;8:317-21. Available at: http://www.rand.org/content/dam/rand/pubs/reprints/2005/RP1114.pdf. Accessed May 20, 2011.
43. Bennett WL, Wilson LM, Bolen S, et al. Oral diabetes medications for adults with type 2 diabetes: an update. Comparative Effectiveness Review No. 27. AHRQ Publication No. 11-EHC038-EF. Agency for Healthcare Research and Quality. March 2011. Available at: http://effectivehealthcare.ahrq.gov/ehc/products/155/644/CER27--OralDiabetesMeds_04-04-2011.pdf. Accessed May 30, 2011.
44. Centers for Medicare & Medicaid Services. 2005 ASP drug pricing files. Medicare Part B drug and biological average sales price. Available at: https://www.cms.gov/McrPartBDrugAvgSalesPrice/02a_2005aspfiles.asp#TopOfPage. Accessed May 21, 2011.
45. Highmark Medicare Services. Drugs and biologicals: self-administered drug exclusions. Available at: https://www.highmarkmedicareservices.com/policy/drug-self.html. Accessed May 27, 2010.
46. Trailblazer Health Enterprises. Self-administered drug exclusions. Available at: http://www.trailblazerhealth.com/Specialty%20Services/Drugs%20and%20Biologicals/SADExclusionJ4.aspx?DomainID=1. Accessed May 21, 2010.
47. Shrank WH, Choudhry NK. Time to fill the doughnuts-health care reform and Medicare Part D. N Engl J Med. 2011;364(7):598-601.
48. Costco.com pricing for 270 400 mg gabapentin tablets, calculated per tablet in the 100-tablet quantity, then multiplied by 270. Available at: http://www.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm=gabapentin&Drug=GABAPENTIN. Accessed May 27, 2011.
49. Drugstore.com pricing for 270 400 mg gabapentin tablets. Available at: http://www.drugstore.com/gabapentin/neurontin/400mg-capsules/qxn53746010301. Accessed May 27, 2011.
50. RxOutreach eligibility. Available at: http://www.rxoutreach.org/eligibility/. Accessed May 16, 2011.
51. RxOutreach medications available. Pricing is based on any strength and quantity (e.g., a patient using 1 tablet per day pays the same price as a patient paying 3 tablets per day. Available at: http://www.rxoutreach.org/medications/. Accessed May 27, 2011.
52. Bayliss EA, Ellis JL, Delate T, Steiner JF, Raebel MA. Characteristics of Medicare Part D beneficiaries who reach the drug benefit threshold in both of the first two years of the Part D benefit. Med Care. 2010;48(2):267-72.
53. Babbie E. The Practice of Social Research: Fourth Edition. Belmont, CA: Wadsworth Publishing. 1986.
54. Bridges JF. Stated preference methods in health care evaluation: an emerging methodological paradigm in health economics. Appl Health Econ Health Policy. 2003;2(4):213-24.