Impact of Medicare Part D Coverage Gap Closure on Health Outcomes

医疗保险 D 部分覆盖缺口缩小对健康结果的影响

• 批准号: 9382245
• 负责人: Cameron Maxwell Kaplan
• 金额: $ 56.25万
• 依托单位: UNIVERSITY OF TENNESSEE HEALTH SCI CTR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9382245
• 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; 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; 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; service utilization

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）包括逐步缩小医疗保险D部分覆盖范围差距（或 "甜甜圈洞"）的处方药。从2011年开始，药品制造商开始提供50%的折扣， 所有品牌药品的个人在覆盖范围的差距。2011年至2020年，政府补贴 品牌药和非专利药将慢慢填补剩余的差距。覆盖率差距导致 慢性病患者的药物依从性显著下降，这反过来又导致 不受控制的症状和不良的健康后果。随着政策的实施， 对于在旧政策下已经达到差距的个人，购买药物将减少， 这可能导致依从性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，往往需要用许多昂贵的药物进行治疗。 治疗对少数民族患者提出了独特的挑战，他们的慢性病患病率较高， 并且通常需要更多的药物和更昂贵的药物来控制他们的病情。在本研究中， 我们计划研究覆盖率差距的缩小是否会导致现实世界的依从性改善， 健康成果。使用2006 - 2017年医疗保险索赔数据的5%全国样本，我们将研究 覆盖差距的影响：1）通过药物依从性测量的预期行为， 受益阶段和药物类型，2）非药房医疗保健利用和结局，以及3）政策是否 导致了种族和族裔少数群体的不同结果。我们的研究将使用差异中的差异 非参数匹配的方法，比较那些以前有政策的人之间的影响 差距中的覆盖率，以及那些面临标准福利的人。领取低收入补贴的受益人 没有面临覆盖缺口，因此不会因该政策而改变福利。我们将 根据经验证的基于人口普查的SES，将这些患者与类似的近贫困人群进行比较 在2010年之前，没有获得补贴的人因此面临覆盖差距。本研究将 首先审查ACA下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 此外，我们还将确定覆盖缺口的设计是否导致药物利用率下降 在整个一年或仅在覆盖缺口期间，表明个人 能够预测未来的医疗保健支出。这对理解行为有着重要的意义 在具有不同覆盖阶段的其他保险利益设计下（例如，免赔额、承保范围限制）。 这项研究将提供关于处方费用分担如何影响医疗保健利用的重要信息 以及这些重要终点的差异，并将提供重要信息 向政策制定者提供关于如何设计保险福利和减轻不遵守规定的后果的建议。