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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)包括逐步缩小联邦医疗保险D部分覆盖差距的条款(或 “甜甜圈洞”)来买处方药。从2011年开始，药品制造商开始提供50%的折扣所有品牌药品都在覆盖缺口中的个人。2011至2020年间，政府对品牌和仿制药都将慢慢填补剩余的空白。覆盖范围的差距导致了慢性病患者的服药依从性显著下降，这反过来又导致不受控制的症状和不利的健康后果。随着政策的生效，每年的总成本对于在旧政策下达到缺口的个人来说，购买药物的数量将会减少，这可能导致遵守情况和健康结果的显著改善。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进行治疗。治疗对少数族裔患者提出了独特的挑战，他们的慢性病患病率较高，而且通常需要更多的药物和更昂贵的药物来管理他们的病情。在这项研究中，我们计划研究覆盖差距的缩小是否会导致实际遵守情况的改善，以及健康结果。使用2006-2017年5%的全国医疗保险索赔数据样本，我们将检查覆盖差距缩小对以下方面的影响：1)通过药物依从性衡量的预期行为福利阶段和药物类型，2)非药房医疗保健利用和结果，以及3)政策是否导致了种族和少数民族的不同结果。我们的研究将使用差异中的差异使用非参数匹配的方法，比较策略的影响差距中的保险，以及那些面临标准福利的人。接受低收入补贴的受益人没有面临覆盖缺口，因此不会因为这项政策而在福利方面有任何变化。我们会根据经过验证的基于人口普查的SES，将这些患者与类似的接近贫困的人进行比较衡量哪些人没有得到补贴，因此在2010年前面临覆盖缺口。这项研究将是首先审查ACA下的初始覆盖缺口关闭的影响，并将提供及时和关键的关于高患者成本分担的福利设计如何影响患者行为的信息。在……里面此外，我们将确定覆盖缺口的设计是否导致药物使用率的下降在全年或仅在覆盖空白期内，表示个人能够预测未来的医疗保健支出。这对于理解行为有重要的意义在具有不同承保阶段的其他保险福利设计下(例如，免赔额、承保限额)。这项研究将提供有关处方费用分担如何影响医疗保健利用的重要信息以及这些重要终点之间的差异，并将提供重要信息向政策制定者介绍如何设计保险福利，并减轻不遵守规定的后果。