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。有双重资格获得医疗补助的精神疾病、残疾医疗保险受益人健康状况不佳，收入非常低，药房利用率很高。当2006年1月实施医疗保险药品福利(D部分)时，600万符合双重资格的受益人从医疗补助过渡到医疗保险药品覆盖范围。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担增加的风险。尽管越来越多的证据表明，对治疗慢性病的维持性药物的需求对费用分担高度敏感，而且药物使用量的减少导致其他医疗保健利用的增加，抵消了大部分药房支出的“节省”，但费用分担的增加还是得以实施。我们计划研究联邦医疗保险D部分费用分担政策对符合双重资格的精神障碍受益人的治疗模式和费用的影响。这项研究的目的是考察共同支付的增加对(1)处方药的使用和支出模式的影响，以及(2)具有双重资格的精神障碍受益人的卫生服务利用和支出的模式。我们将把D部分的实施作为一个自然的实验来研究成本分担变化的影响。我们将采用差异法，该方法依赖于健康计划中独特的管理数据集，该计划与联邦医疗保险和医疗补助签订了合同，为低收入人口提供医疗服务。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的药品成本控制政策。如果我们发现D部分处方药自付导致停止治疗或减少续药依从性和增加服务使用，联邦医疗保险政策制定者可能会选择免除某些药物类别或受益人的自付政策。 与公共卫生的相关性。处方药是大多数精神障碍循证护理的关键组成部分。新的医疗保险药品福利的实施代表着为具有双重资格获得医疗保险和医疗补助的精神障碍患者提供处方药的资金来源发生了重大变化。至关重要的是，了解从医疗补助过渡到医疗保险药物覆盖的受益人的费用分担增加将如何影响精神药物和其他处方药的使用以及健康结果。

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.