Impact of Medicare Part D Gap Closure on Health Outcomes

医疗保险 D 部分缺口缩小对健康结果的影响

基本信息

批准号：
9918088
负责人：
Cameron Maxwell Kaplan
金额：
$ 7.51万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-15 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9918088
关键词：
Address Adherence Affect Affordable Care Act Behavior Calendar Cardiovascular Diseases Caring Censuses Chronic Chronic Disease Complex Consumption Cost Sharing Data Deductibles Diabetes Mellitus Drug Costs Drug Prescriptions Drug Utilization Emergency department visit Federal Government Financial Hardship Future Generic Drugs Goals Government Subsidy Health Health Care Costs Health Insurance Healthcare Heart failure High Prevalence Hospitalization Hypertension Individual Insurance Benefits Lead Low income Manufacturer Name Measures Medicare Medicare claim Minority Morals Names Not Hispanic or Latino Outcome Patients Pharmaceutical Preparations Pharmacologic Substance Phase Police Policies Policy Maker Population Privatization Provider Research Design Sampling Services Stroke Symptoms Time base behavioral study beneficiary care outcomes compliance behavior cost design discount ethnic minority population hazard health care service health care service utilization health difference improved medication compliance multiple chronic conditions non-drug programs racial and ethnic disparities racial minority

项目摘要

The Affordable Care Act (ACA) included provisions to gradually close the Medicare Part D coverage gap (or “doughnut hole”) for prescription drugs. Starting in 2011, drug manufacturers began offering a 50% discount on all brand name drugs for individuals in the coverage gap. Between 2011 and 2020, government subsidies for both brand name and generic drugs will slowly fill in remaining parts of the gap. The coverage gap has led to significant decreases in medication adherence for patients with chronic illness, which has, in turn, resulted in uncontrolled symptoms and adverse health outcomes. As the policy goes into effect, the total annual cost of purchasing medications will decrease for individuals that would have reached the gap under the old policy, which could lead to significant improvements in adherence and health outcomes. Two-thirds of Medicare beneficiaries have multiple chronic conditions, and often require treatment with many costly medications. Treatment presents unique challenges in minority patients, who have a higher prevalence of chronic illness, and often require more medications and costlier medications in order to manage their conditions. In this study, we plan to examine whether the closure of the coverage gap leads to real-world improved adherence and health outcomes. Using a 5% national sample of Medicare Claims data from 2006-2017, we will examine the impact of the coverage gap closure on: 1) anticipatory behavior measured by medication adherence across benefit phases and drug types, 2) non-pharmacy healthcare utilization and outcomes and 3) whether the policy led to differential outcomes for racial and ethnic minorities. Our study will use a difference-in-differences approach with nonparametric matching, comparing the impact of the policy between those who previously had coverage in the gap, and those who faced standard benefits. Beneficiaries who received low-income subsidies did not face a coverage gap, and thus will not have any change in benefits as a result of the policy. We will compare these patients to a similar group of near-poor individuals based on a validated census-based SES measure who did not receive subsidies, and thus faced the coverage gap prior to 2010. This study will be the first to examine the impact of the initial coverage gap closure under the ACA, and will provide timely and critical information on the impact how benefit designs with high patient cost sharing influence patient behavior. In addition, we will determine whether the design of the coverage gap resulted in decreases in drug utilization throughout the entire year or only during the coverage gap period, indicating the degree to which individuals are able anticipate future health care spending. This has important implications for understanding behavior under other insurance benefit designs that have different coverage phases (e.g., deductibles, coverage limits). This study will provide important information about how prescription cost-sharing affects healthcare utilization and health outcomes, as well as disparities in these important endpoints, and will provide important information to policy makers about how to design insurance benefits and to lessen the consequences of poor adherence.

《平价医疗法案》（ACA）包括逐渐缩小Medicare D部分覆盖差距的规定（或 “甜甜圈孔”）用于处方药。从2011年开始，药品制造商开始提供50％的折扣覆盖差距中的所有品牌毒品。在2011年至2020年之间，政府补贴品牌名称和通用药物都将慢慢填补差距的剩余部分。覆盖差距已导致慢性病患者的药物依从性大幅下降，这又导致不受控制的症状和不良健康结果。随着政策生效，年总成本为对于在旧政策下将要达到差距的个人，购买药物将减少，这可能会导致依从性和健康成果的重大改善。三分之二的医疗保险受益人患有多种慢性病，通常需要使用许多昂贵的药物治疗。治疗对慢性病患病率较高的少数族裔患者提出了独特的挑战通常需要更多的药物和更具成本的药物来管理其状况。在这项研究中，我们计划检查覆盖差距的封闭是否会导致现实世界的依从性和健康结果。使用2006年至2017年的5％国家医疗保险索赔数据样本，我们将检查覆盖范围封闭的影响：1）通过遵守药物遵守的预期行为益处阶段和药物类型，2）非药房医疗保健利用和结果以及3）是否政策导致种族和少数民族的差异结果。我们的研究将使用差异差异与非参数匹配的方法，将政策的影响进行比较差距中的覆盖范围，以及面临标准福利的人。获得低收入补贴的受益人没有面临覆盖差距，因此由于政策而不会改变福利。我们将根据经过验证的基于人口普查的SES将这些患者与类似的近乎笨拙的个体进行比较衡量未获得补贴的人，因此在2010年之前面临覆盖差距。这项研究将是首先要检查ACA下的初始覆盖差距的影响，并将提供及时，关键信息有关如何用高患者成本分担的影响的影响影响患者行为的信息。在此外，我们还将确定覆盖范围的设计是否导致药物利用率下降在整个全年或仅在覆盖差距期间，表明个人的程度能够预期未来的医疗保健支出。这对理解行为具有重要意义在其他保险福利设计下，具有不同的覆盖阶段（例如，免赔额，覆盖范围）。这项研究将提供有关处方成本分担如何影响医疗保健利用的重要信息和健康结果以及这些重要终点的差异，并将提供重要信息致政策制定者，以了解如何设计保险福利并减少依从性差的后果。