Differences In Incentives Between Stand Alone Medicare Drug Coverage vs Medicare

独立医疗保险药物承保与医疗保险之间的激励差异

• 批准号: 7896221
• 负责人: KOSALI ILAYPERUMA SIMON
• 金额: $ 6.05万
• 依托单位: CORNELL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7896221
• 关键词: Accounting; Australia; Behavior; Benchmarking; Caring; Characteristics; Complement; Cost Sharing; Cream; Data; Data Set; Drug Costs; Drug Insurance; Drug Prescriptions; Enrollment; Ensure; Exhibits; Fee-for-Service Plans; Formularies; Funding Agency; Future; Government; Growth; Guidelines; Health; Health Care Costs; Hospital Costs; Incentives; Individual; Insurance Carriers; International; Lead; Marketing; Measures; Medical; Medicare; Medicare Part A; Modeling; National Formulary; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Policies; Policy Research; Preventive; Price; Public Policy; Recording of previous events; Relative (related person); Research; Rest; Scheme; Signal Transduction; Social Welfare; Structure; Surveys; Testing; Time; United States Centers for Medicare and Medicaid Services; base; beneficiary; cost; design; flexibility; non-drug; payment; prior authorization; programs; public health relevance; theories; tool

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.

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）或医疗保险优势（MAPDP）来获得药物覆盖，该计划将a， B和D部分捆绑在一起。理论预测，MAPDP的支付函数涉及医疗保健总成本，比PDP有更强的动机减少处方药物的慷慨度，因为使用这些药物表明患者也有很高的非药物成本。在开放注册期间，这些潜在的注册者可能会被劝阻注册，而当前的注册者可能会被鼓励退出注册（选择假设）。在公开登记后，mapdp有更强的动机设计处方，通过慷慨地覆盖那些降低医院成本的药物来优化医疗管理（Chandra， Gruber和McKnight，即将出版）（医疗管理假说）。本R03申请的目的是在所有D部分计划设计的规则范围内，测试2006-2010年期间的MAPDP和PDP公式设计是否在理论预测的方式上存在系统差异。我们的目标是：具体目标1：测试在开放登记的药物中，如果使用表明患者也有很高的非药物成本（选择假设），MAPDP处方是否比PDP处方更慷慨。具体目标2：测试开放入组后，MAPDP处方是否比PDP处方更慷慨，这些药物的使用可以降低非药物成本。（医疗管理假说）。具体目标3：研究决定选择规模、医疗管理规模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，我们期望MAPDP计划在开放登记期间相对于PDP计划的剩余时间，对某些药物的慷慨选择激励，以及在开放登记期间相对于PDP计划的剩余时间，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mapdp和pdp的药物计划设计信息，以及医院费用与某些药物使用之间的联系信息。计划慷慨对药物的措施包括知道它是否在处方上，如果是，知道它的共同支付结构，需要事先批准，步骤治疗和数量限制的补充。虽然在规划设计方面有一些所有规划必须遵循的指导方针，但在设计上允许有相当大的灵活性。我们预计我们的研究结果将通过展示MAPDP与PDP计划如何使用市场设计中的灵活性，对与医疗保险D部分相关的公共政策和研究产生有意义的影响。