Differences In Incentives Between Stand Alone Medicare Drug Coverage vs Medicare

描述（由申请人提供）：根据医疗保险D部分，老年人可以选择通过独立的处方药计划（PDP）或通过医疗保险优势（MAPDP）获得药物保险，后者将A，B和D部分捆绑在一起。理论预测，MAPDP，其支付功能涉及总的医疗保健成本，有一个更强的激励比PDP，以减少处方慷慨的药物，其使用的信号，病人也有很高的非药物费用，在开放注册期间，这样的潜在的登记者可以不鼓励登记和当前的登记者可以鼓励退出（选择假设）。在开放注册后，MAPDP有更强的动力设计处方集，通过慷慨地覆盖药物的使用降低医院成本来优化医疗管理（Chandra，Gruber和McKnight，即将出版）（医疗管理假设）。本R 03申请的目的是在管理所有D部分计划设计的规则范围内，测试2006-2010年期间MAPDP和PDP处方集设计是否在理论预测的方式上彼此存在系统性差异。我们的目标是：具体目标1：测试在开放招募期间，MAPDP处方集是否不如PDP处方集慷慨，因为药物的使用表明患者也有高的非药物费用（选择假设）。具体目标二：测试在开放招募药物后，MAPDP处方集是否比PDP处方集更慷慨，这些药物的使用可以降低非药物成本。（医学管理假说）。具体目标3：研究决定选择量、医疗管理量以及净效应如何随时间演变的因素。 我们的基本估计策略是一种“差异中的差异”方法，使用的事实是，我们预计相对于PDP计划，MAPDP计划将在开放入组期间表现出对某些药物的慷慨选择激励，相对于PDP计划，在开放入组期间表现出对某些药物的医疗管理激励。我们计划使用几个数据集，其中包含有关MAPDP和PDP的药物计划设计的信息，以及有关医院成本和某些药物使用之间联系的信息。对药物的计划慷慨的措施包括知道它是否在处方集上，如果是，知道它的共同支付结构，需要事先授权，分步治疗和再填充的数量限制。虽然有一些指导方针，所有计划必须遵循有关计划设计，他们被允许在设计相当大的灵活性。我们预计我们的研究结果将对公共政策和与医疗保险D部分相关的研究产生有意义的影响，通过展示MAPDP与PDP计划如何使用市场设计中的灵活性。 公共卫生相关性：本提案调查了通过综合计划（Medicare Advantage）提供的Medicare药物覆盖范围是否考虑了药物和非药物成本之间的溢出效应和联系，以设计相对于独立药物覆盖范围的药物处方集。

DESCRIPTION (provided by applicant): Under Medicare Part D, seniors can choose to receive drug coverage through either a stand-alone Prescription Drug Plan (PDP) or through Medicare Advantage (MAPDP), which bundles together Parts A, B and D. Theory predicts that MAPDPs, whose payoff function involves total health care costs, have a stronger incentive than PDPs to decrease the formulary generosity of drugs whose use signals that the patient also has high non-drug costs, during open enrollment periods when such potential enrollees can be discouraged from enrolling and current enrollees can be encouraged to disenroll (the selection hypothesis). After open enrollment, MAPDPs have stronger incentives to design formularies that optimize medical management by generously covering drugs whose use reduces hospital costs (Chandra, Gruber and McKnight, forthcoming) (the medical management hypothesis). The objective of this R03 application is to test whether MAPDP and PDP formulary designs during 2006-2010 are systematically different from each other in ways predicted by theory, within the confines of rules governing all Part D plan design. Our aims are: Specific Aim 1: To test whether MAPDP formularies are less generous than PDP formularies during open enrollment for drugs whose use signals that a patient also has high non-drug costs (Selection hypothesis). Specific Aim 2: To test whether MAPDP formularies are more generous than PDP formularies after open enrollment for drugs whose use can lower non-drug costs. (Medical management hypothesis). Specific Aim 3: To study factors that determine the magnitude of selection, the magnitude of medical management and how the net effect evolves over time. Our basic estimation strategy is a "differences in differences" approach using the fact that we expect MAPDP plans will exhibit the selection incentive in their generosity towards certain drugs during open enrollment relative to rest of the plan year, relative to PDP plans and exhibit the medical management incentive towards certain drugs during the rest of the year relative to the open enrollment period, relative to PDP plans. We plan to use several data sets that contain information on drug plan design of MAPDPs and PDPs, as well as information on the connection between hospital costs and use of certain drugs. The measures of plan generosity towards a drug include knowing whether it is on the formulary, and if so, knowing its co- payment structure, need for prior authorization, step therapy and quantity limits on refills. While there are some guidelines that all plans must follow regarding plan design, they are allowed considerable flexibility in design. We anticipate the results of our research will have a meaningful impact on public policy and research related to Medicare Part D by showing how the flexibility built into the design of the market is being used by MAPDP vs. PDP plans. PUBLIC HEALTH RELEVANCE: This proposal investigates whether Medicare drug coverage delivered through a comprehensive program (Medicare Advantage) takes into account the spillovers and connections between drug and non-drug costs in the design of their drug formularies relative to stand-alone drug coverage.