Medicare Part D Cost-Sharing and Treatment of Mental Disorders Among Disabled Dua

描述（由申请人提供）：社会保障残疾收入（SSDI）和医疗保险是为患有严重和持续性精神疾病的成年人提供的重要社会保险计划。精神疾病、残疾医疗保险受益人有双重资格获得医疗补助，他们健康状况不佳，收入很低，而且药房使用率很高。当医疗保险药物福利（D部分）于2006年1月实施时，600万双重合格受益人从医疗补助计划过渡到医疗保险药物覆盖。大多数符合双重资格的残疾受益人在这一筹资变化后面临处方药费用分摊增加的风险。尽管越来越多的证据表明，治疗慢性疾病的维持药物的需求对费用分摊非常敏感，而且药物使用的减少导致其他保健利用的增加，从而抵消了药房支出的大部分“节省”，但还是颁布了增加费用分摊的规定。我们计划研究医疗保险D部分费用分担政策对精神障碍双重合格受益人的治疗模式和费用的影响。本研究的目的是检验共同支付增加对(1)处方药使用和支出模式的影响，以及(2)精神障碍双重资格受益人的卫生服务使用和支出模式的影响。我们将把D部分的实施作为一个自然实验来研究成本分摊变化的影响。我们将采用差异中的差异方法，该方法依赖于来自医疗保险和医疗补助合同的健康计划的独特管理数据集，为低收入人群提供医疗服务。拟议工作的长期目标是为患有精神障碍的低收入受益人提供联邦和州药品费用控制政策的信息。如果我们发现D部分处方药共同支付导致治疗中断或减少重新补充依从性和增加服务使用，医疗保险政策制定者可以选择豁免某些药物类别或受益人的共同支付政策。

DESCRIPTION (provided by applicant): Social Security Disability Income (SSDI) and Medicare are important social insurance programs for adults with severe and persistent mental illnesses. Mentally ill, disabled Medicare beneficiaries who are dually eligible for Medicaid are in poor health, have very low incomes, and high pharmacy utilization. When the Medicare drug benefit (Part D) was implemented in January 2006, 6 million dually eligible beneficiaries transitioned from Medicaid to Medicare drug coverage. Most dually eligible disabled beneficiaries were exposed to an increase in prescription drug cost-sharing following this change in financing. The cost-sharing increase was enacted in spite of a growing body of evidence showing that demand for maintenance medications to treat chronic conditions is highly sensitive to cost-sharing, and that reductions in medication use lead to increases in other health care utilization that offset much of the "savings" in pharmacy expenditures. We plan to study the effects of the Medicare Part D cost-sharing policy on treatment patterns and costs for dually eligible beneficiaries with mental disorders. The objectives of this study are to examine the impact of the increased co-payments on (1) prescription drug utilization and expenditure patterns, and (2) patterns in health service utilization and expenditures among dually eligible beneficiaries with mental disorders. We will use Part D's implementation as a natural experiment to study the effects of cost-sharing changes. We will employ a difference-in-differences methodology that relies on a unique administrative dataset from a health plan that contracts with both Medicare and Medicaid to provide health services to low-income populations. The long-term objective of the proposed work is to inform federal and state pharmaceutical cost-containment policies for low-income beneficiaries with mental disorders. Should we find that Part D prescription drug co-payments lead to treatment discontinuations or reduced refill adherence and increased services use, Medicare policy makers may choose to exempt certain drug classes or beneficiaries from co-payment policies. Relevance to public health. Prescription drugs are a critical component of evidence-based care for most mental disorders. The implementation of the new Medicare drug benefit represents a major change in the financing of prescription drugs for individuals with mental disorders who are dually eligible for Medicare and Medicaid. It is critical to understand the ways in which increased cost-sharing for beneficiaries transitioning from Medicaid to Medicare drug coverage will affect utilization of psychotropic and other prescription drugs as well as health outcomes.