Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Dec;56(12):2304-10.
doi: 10.1111/j.1532-5415.2008.02025.x.

The effect of transitioning to medicare part d drug coverage in seniors dually eligible for medicare and medicaid

William H Shrank  1 , Amanda R Patrick, Alex Pedan, Jennifer M Polinski, Laleh Varasteh, Raisa Levin, Nan Liu, Sebastian Schneeweiss
Affiliations

The effect of transitioning to medicare part d drug coverage in seniors dually eligible for medicare and medicaid

William H Shrank et al. J Am Geriatr Soc. 2008 Dec.

Abstract

Objectives: To evaluate medication use, out-of-pocket spending, and medication switching during the transition period for patients dually eligible for Medicaid and Medicare (dual eligibles).

Design: Time-trend analysis, using segmented linear regression.

Setting: Patient-level pharmacy dispensing data from January 2005 to December 2006 from a large pharmacy chain with stores in 34 states.

Participants: Dual eligibles aged 65 and older.

Measurements: Changes in utilization, patient copayments, and medication switching were analyzed using interrupted time trend analyses. Utilization and spending were evaluated for five study drugs: clopidogrel, proton pump inhibitors (PPIs), warfarin, and statins (essential drugs covered by Part D plans) and benzodiazepines (not covered through Part D but potentially covered through Medicaid).

Results: Drug use for 13,032 dual eligibles was evaluated. There was no significant effect of the transition to Medicare Part D on use of all study drugs, including the uncovered benzodiazepines. Cumulative reductions were seen in copayments for all covered drugs after implementation of Part D, ranging from 25% annually for PPIs to 53% for warfarin, but there was a larger increase in copayments, 91% annually, for benzodiazepines after the transition. The rate of switching medications was 3.0 times as great for the PPIs after implementation of Part D than before implementation, but there was no significant change in the other study drug classes.

Conclusion: These findings in a single, large pharmacy chain indicate that the transition plan for dual eligibles led to less medication discontinuation and switching than many had expected. The substantially greater cost sharing for benzodiazepines highlights the importance of implementing a thoughtful transition plan when executing such a national policy.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1. Utilization of and patient co-pay for selected essential drugs among Dual Eligible seniors.*
* The January and February 2005 datapoints were omitted from this figure because days covered is affected by dispensings received in the previous 1 – 2 months. We did not analyze dispensing data from the end of 2004, so we did not have an accurate measure of days covered in January and February 2005.
Figure 1
Figure 1. Utilization of and patient co-pay for selected essential drugs among Dual Eligible seniors.*
* The January and February 2005 datapoints were omitted from this figure because days covered is affected by dispensings received in the previous 1 – 2 months. We did not analyze dispensing data from the end of 2004, so we did not have an accurate measure of days covered in January and February 2005.
Figure 2
Figure 2. Monthly probabilities of switching between drugs. Switching includes switching between distinct generic entities and switching between branded and generic versions of a single drug
* The July 2006 datapoint for statins, attributable to the entrance of generic simvastatin onto the market, was omitted from the statistical analysis. Similarly, dates after August were omitted for clopidogrel because generic clopidogrel became available in September.
See this image and copyright information in PMC

References

    1. The Henry J. Kaiser Family Foundation. Medicare Prescription Drug Coverage Among Medicare Beneficiaries: Data Update. The Henry J. Kaiser Family Foundation. [Accessed 10/10/2007]. Available at: http://www.kff.org/medicare/upload/7453.pdf.
    1. The Henry J. Kaiser Family Foundation. Benefit Design and Formularies of Medicare Drug Plans: A Comparison of 2006 and 2007 Offerings. [Accessed October 10, 2007]. 11/14/2006. Available at: http://www.kff.org/medicare/7589.cfm.
    1. Centers for Medicare & Medicaid Services. Medicare Modernization Act. Final Guidelines—Formularies. CMS Strategy for Affordable Access to Comprehensive Drug Coverage. Guidelines for Reviewing Prescription Drug Plan Formularies and Procedures. 2007. [Accessed April 20, 2006]. Available at: http://www.amcp.org/data/nav_content/Final%20CY%202007%20Formulary%20Gui....
    1. Smith V, Gifford K, Kramer S, et al. The transition of dual eligibles to Medicare Part D prescription drug coverage: State actions during implementation. Results from a 50-State Snapshot. Health Management Associates and Kaiser commission on Medicaid and the Uninsured. Available at: http://www.kff.org/medicaid/upload/7467.pdf.
    1. Elliott RA, Majumdar SR, Gillick MR, et al. Benefits and consequences for the poor and the disabled. N Engl J Med. 2005;353:2739–2741. - PubMed

Publication types