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J Gerontol B Psychol Sci Soc Sci. 2010 Jul;65(4):502-7. doi: 10.1093/geronb/gbp111. Epub 2009 Dec 14.

How the Medicare Part D drug benefit changed the distribution of out-of-pocket pharmacy spending among older beneficiaries.

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1
Department of Health Policy & Management, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. ytzhang@pitt.edu

Abstract

OBJECTIVE:

To examine the impact of the Medicare drug benefit (Part D) on the distribution of out-of-pocket pharmacy spending among older adults.

METHODS:

We used a pre-post-with-comparison-group design to compare four groups of beneficiaries continuously enrolled in a Medicare Advantage plan between 2004 and 2007: three intervention groups with no or limited (quarterly caps of $150 or $350) prior coverage that obtained Part D benefits in 2006 and a comparison group with stable drug coverage from 2004 to 2007.

RESULTS:

The comparison group's out-of-pocket drug spending was stable throughout 2004-2007, whereas Part D reduced out-of-pocket spending 13.4% among those without prior coverage (95% confidence interval [CI] -17.1% to -9.1%) and 15.9% among those with $150 quarterly caps (95% CI -19.1% to -12.8%) relative to the comparison group. Individuals in the top decile of drug spending paid a greater share of their costs out-of-pocket than others in the top 5 deciles.

DISCUSSION:

Although Part D reduced out-of-pocket expenditures for older adults, those with the highest drug spending still pay a substantial share of their drug costs out-of-pocket. Thus, the Part D benefit does not achieve a primary purpose of insurance-to offer the greatest financial protection to those at the highest risk.

PMID:
20008482
PMCID:
PMC2883868
DOI:
10.1093/geronb/gbp111
[Indexed for MEDLINE]
Free PMC Article
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