Impact of Medicare Part D in Dual Eligibles with Schizophrenia

描述（由申请人提供）：2003年《医疗保险处方药、改进和现代化法案》建立了一项新的医疗保险药品福利（D部分），使受益人能够获得私人医疗保险处方药计划。新法案对640万“双重资格者”，即同时参加医疗补助和医疗保险的低收入老年人和残疾人特别重要，因为它导致他们的处方药覆盖范围从医疗补助转向私人D部分计划。由于这种转变，许多双重资格患者的共同支付额增加，并在d部分下首次面临差异（或分层）共同支付。这些变化对双重资格的精神分裂症患者的影响可能特别严重。抗精神病药物是治疗这种精神疾病的主要药物。依从这些药物对减少急性精神病发作和精神病住院至关重要。本项目有三个目标：(1)确定向医疗保险D部分过渡的影响，包括(i)总体和（ii）按抗精神病药物使用和非药物精神卫生保健服务使用提供的国家援助水平；(2)确定D部分规定的处方共付额变化的影响，即(i)最低共付额增加和（ii）非专利/品牌共付额差异增加对抗精神病药物使用和非药物精神卫生保健服务使用的影响；(3)确定医疗保险D部分和处方共付额变化对双重符合条件的精神分裂症患者总（药物+非药物）精神卫生保健成本的净影响。该研究将使用准实验设计进行多州分析，通过将所有州医疗补助计划的双重合格精神分裂症患者的数据与他们的医疗保险索赔和D部分文件联系起来。我们的研究结果将有助于指导设计和完善围绕D部分的联邦和州一级政策，以便为这些最无力负担不需要药物的弱势患者提供药物获取和成本之间的平衡。

DESCRIPTION (provided by applicant): The Medicare Prescription Drug, Improvement and Modernization Act of 2003 established a new Medicare drug benefit (Part D) that gives beneficiaries access to a private Medicare prescription drug plan. The new law had particular relevance for the 6.4 million "dual eligibles," low-income elderly and individuals with disabilities who are enrolled in both Medicaid and Medicare since it resulted in a shift in their prescription coverage from Medicaid to private Part D plans. As a result of this transition, many dual eligibles had increases in their co-payments and faced differential (or tiered) co-payments for the first time under Part D. The impact of these changes may be particularly acute for dual eligible patients with schizophrenia. Antipsychotic drugs are the mainstay therapy for this mental illness. Compliance with these drugs is critical to reduce acute psychotic episodes and psychiatric hospitalizations. This project s three aims: (1) To determine the impact of the transition to Medicare Part D, both (i) overall and (ii) by level of state assistance provided on antipsychotic medication use and non-drug mental health care service use; (2) To determine the impact of changes in prescription co-payments under Part D, namely (i) increases in minimum co-payments and (ii) increases in generic/brand co-payment differentials on antipsychotic medication use and non-drug mental health care service use; and (3) To determine the net impact of Medicare Part D and prescription co-payment changes on total (drug + non-drug) mental health care costs in dual eligible patients with schizophrenia. The study will conduct a multi-state analysis using a quasi-experimental design by linking pre-Part D data on dual eligible patients with schizophrenia across all state Medicaid programs with their Medicare claims and Part D files. Our study findings will help guide design and refine federal- and state-level policies surrounding Part D so as to provide a balance between medication access and costs in such vulnerable patients who can least afford to be without needed medications. PUBLIC HEALTH RELEVANCE: Our study findings will inform policymakers about the unintended negative and positive consequences of the transition to Medicare Part D in dual eligible patients with schizophrenia. They will help guide design and refine policies surrounding Part D so as to provide a balance between medication access and costs in such vulnerable patients who can least afford to be without needed medications.