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
. 2014 Mar 1;65(3):323-9.
doi: 10.1176/appi.ps.201300123.

Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar I disorder among dual beneficiaries

Marguerite E Burns, Alisa B Busch, Jeanne M Madden, Robert F Le Cates, Fang Zhang, Alyce S Adams, Dennis Ross-Degnan, Stephen B Soumerai, Haiden A Huskamp

Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar I disorder among dual beneficiaries

Marguerite E Burns et al. Psychiatr Serv. .

Abstract

Objective: In January 2006 insurance coverage for medications shifted from Medicaid to Medicare Part D private drug plans for the six million individuals enrolled in both programs. Dual beneficiaries faced new formularies and utilization management policies. It is unclear whether Part D, compared with Medicaid, relaxed or tightened psychiatric medication management, which could affect receipt of recommended pharmacotherapy, and emergency department use related to treatment discontinuities. This study examined the impact of the transition from Medicaid to Part D on guideline-concordant pharmacotherapy for bipolar I disorder and emergency department use.

Methods: Using interrupted-time-series analysis and Medicaid and Medicare administrative data from 2004 to 2007, the authors analyzed the effect of the coverage transition on receipt of guideline-concordant antimanic medication, guideline-discordant antidepressant monotherapy, and emergency department visits for a nationally representative continuous cohort of 1,431 adults with diagnosed bipolar I disorder.

Results: Sixteen months after the transition to Part D, the proportion of the population with any recommended use of antimanic drugs was an estimated 3.1 percentage points higher than expected once analyses controlled for baseline trends. The monthly proportion of beneficiaries with seven or more days of antidepressant monotherapy was 2.1 percentage points lower than expected. The number of emergency department visits per month temporarily increased by 19% immediately posttransition.

Conclusions: Increased receipt of guideline-concordant pharmacotherapy for bipolar I disorder may reflect relatively less restrictive management of antimanic medications under Part D. The clinical significance of the change is unclear, given the small effect sizes. However, increased emergency department visits merit attention for the Medicaid beneficiaries who continue to transition to Part D.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1. Guideline-concordant pharmacotherapy for bipolar I disorder received among dual beneficiaries with a diagnosis of bipolar I disorder, 2005–2007a
Abbreviation: MPR = Medication possession ratio a The predicted line reflects the regression results for each segment. The counterfactual line continues the pre-Part D trend illustrating the expected trend in the absence of Part D. The shaded area, December 2005-March 2006, represents the Part D phase-in period. These data points are not included in the regression model. b Difference of 4.6%, p = .003 c Difference of 4.25%, p = .07 d Difference of −10.96%, p = .04
FIGURE 2
FIGURE 2. Monthly emergency department use for any cause among dual beneficiaries with a diagnosis of bipolar I disordera
a) Mean proportion of the population with any emergency department visit b) Mean number of emergency department visits in the population Abbreviation: ED = Emergency Department a The predicted line reflects the regression results for each segment. The counterfactual line continues the pre-Part D trend illustrating the expected trend in the absence of Part D. b Difference is 18.75% (i.e., .03/.16 visits), p < .05 The shaded area, December 2005-March 2006, represents the Part D phase-in period. These data points are not included in the regression model.
FIGURE 2
FIGURE 2. Monthly emergency department use for any cause among dual beneficiaries with a diagnosis of bipolar I disordera
a) Mean proportion of the population with any emergency department visit b) Mean number of emergency department visits in the population Abbreviation: ED = Emergency Department a The predicted line reflects the regression results for each segment. The counterfactual line continues the pre-Part D trend illustrating the expected trend in the absence of Part D. b Difference is 18.75% (i.e., .03/.16 visits), p < .05 The shaded area, December 2005-March 2006, represents the Part D phase-in period. These data points are not included in the regression model.
See this image and copyright information in PMC

References

    1. Jacobson G, Neuman T, Damico A. Medicare's role for dual eligible beneficiaries. Washington, D.C.: Kaiser Family Foundation; 2012. Available at http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8138-02.pdf.
    1. Donohue J. Mental health in the Medicare part D drug benefit: A new regulatory model? Health Affairs. 2006;25:707–719. - PubMed
    1. Riley GF, Lubitz JD, Zhang N. Patterns of health care and disability for Medicare beneficiaries under 65. Inquiry. 2003;40:71–83. - PubMed
    1. Centers for Medicare & Medicaid Services. Medicare Prescription Drug Benefit Final Rule. Federal Register. 2005;70:4193–7585. - PubMed
    1. Centers for Medicare and Medicaid Services. Baltimore, MD: Centers for Medicare and Medicaid Services; 2008. Medicare Prescription Drug Benefit Manual, Chapter 6. Available at http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugC.... - PubMed

Publication types

MeSH terms