Impact of Medicare Part D in Dual Eligibles with Schizophrenia

描述（由申请人提供）：2003年的医疗保险处方药，改进和现代化法案建立了一个新的医疗保险药物福利（D部分），使受益人获得私人医疗保险处方药计划。新法律对640万“双重杀手”，低收入老年人和残疾人特别重要，他们参加了医疗补助和医疗保险，因为它导致他们的处方覆盖范围从医疗补助转移到私人D部分计划。由于这一过渡，许多双杀增加了他们的共同支付，并首次面临D部分下的差异（或分层）共同支付。这些变化的影响可能是特别严重的双重资格的精神分裂症患者。抗精神病药物是这种精神疾病的主要治疗方法。遵守这些药物是至关重要的，以减少急性精神病发作和精神病住院。该项目的三个目标：（1）确定向医疗保险D部分过渡的影响，包括（i）总体和（ii）对抗精神病药物使用和非药物精神卫生保健服务使用提供的国家援助水平;（2）确定D部分规定的处方共同支付额变化的影响，即（i）增加最低共付额，以及（ii）增加抗精神病药物使用和非药物精神卫生保健服务使用的非专利/品牌共付额差异;和（3）确定医疗保险D部分和处方共同支付变化对双重合格精神分裂症患者的总（药物+非药物）精神卫生保健费用的净影响。该研究将使用准实验设计进行多状态分析，将所有州医疗补助计划中双重合格精神分裂症患者的D部分前数据与他们的医疗保险索赔和D部分文件联系起来。我们的研究结果将有助于指导设计和完善围绕D部分的联邦和州一级政策，以便在这些最不可能负担得起不需要药物的弱势患者中提供药物获取和成本之间的平衡。 公共卫生相关性：我们的研究结果将告知政策制定者关于在双重合格的精神分裂症患者中过渡到医疗保险D部分的意外负面和积极后果。他们将帮助指导设计和完善围绕D部分的政策，以便在这些最不可能负担得起没有所需药物的弱势患者的药物获取和费用之间提供平衡。

DESCRIPTION (provided by applicant): The Medicare Prescription Drug, Improvement and Modernization Act of 2003 established a new Medicare drug benefit (Part D) that gives beneficiaries access to a private Medicare prescription drug plan. The new law had particular relevance for the 6.4 million "dual eligibles," low-income elderly and individuals with disabilities who are enrolled in both Medicaid and Medicare since it resulted in a shift in their prescription coverage from Medicaid to private Part D plans. As a result of this transition, many dual eligibles had increases in their co-payments and faced differential (or tiered) co-payments for the first time under Part D. The impact of these changes may be particularly acute for dual eligible patients with schizophrenia. Antipsychotic drugs are the mainstay therapy for this mental illness. Compliance with these drugs is critical to reduce acute psychotic episodes and psychiatric hospitalizations. This project s three aims: (1) To determine the impact of the transition to Medicare Part D, both (i) overall and (ii) by level of state assistance provided on antipsychotic medication use and non-drug mental health care service use; (2) To determine the impact of changes in prescription co-payments under Part D, namely (i) increases in minimum co-payments and (ii) increases in generic/brand co-payment differentials on antipsychotic medication use and non-drug mental health care service use; and (3) To determine the net impact of Medicare Part D and prescription co-payment changes on total (drug + non-drug) mental health care costs in dual eligible patients with schizophrenia. The study will conduct a multi-state analysis using a quasi-experimental design by linking pre-Part D data on dual eligible patients with schizophrenia across all state Medicaid programs with their Medicare claims and Part D files. Our study findings will help guide design and refine federal- and state-level policies surrounding Part D so as to provide a balance between medication access and costs in such vulnerable patients who can least afford to be without needed medications. PUBLIC HEALTH RELEVANCE: Our study findings will inform policymakers about the unintended negative and positive consequences of the transition to Medicare Part D in dual eligible patients with schizophrenia. They will help guide design and refine policies surrounding Part D so as to provide a balance between medication access and costs in such vulnerable patients who can least afford to be without needed medications.