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）包括逐渐关闭Medicare D部分覆盖差距的规定（或 “甜甜圈孔”）从2011年开始，药物开始提供50％的折扣在2011年至2020年之间品牌名称和通用药物Willy填补了剩余的差距。慢性疾病患者的药物依从性依从性的大量法令，这又导致随着政策的生效，不受控制的症状和不利的健康结果在旧政策下，购买差距的个人将减少购买药物，这可能导致依从性和健康成果的显着改善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，并且通常需要更多的药物和更具成本的药物来管理它们的病情。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成果。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不同结果。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，以及面对的福利的人。没有面对覆盖差距根据经过验证的基于人口普查的SES将患者与类似的近乎矮人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，关键有关较高的患者成本共享的影响的信息，会影响患者行为此外，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，这表明个人的程度能够预期未来的医疗保健支出。根据其他保险福利设计，这些设计讨厌不同的覆盖阶段（例如可扣除额，覆盖范围）。这项研究将主要关于处方成本分担的进口信息影响医疗保健利用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力于设计福利并减少依从性不佳的后果的政策制定者。