Cardiovascular disease (CVD) affects approximately 77% of the elderly, community-dwelling Medicare population and is the largest driver of hospital admissions, deaths, and health expenditures in this group. Since 2006, the subsidized Part D drug benefit has improved the accessibility of needed medications for people in Medicare, but the specific effects on those with CVD are not well-known, in particular in terms of medication adherence, use of health services, and patient outcomes. Moreover, nothing is known about major trends in these outcomes among elderly Medicare enrollees with CVD in the eight years following Part D implementation. Using strong quasi-experimental methods and the nationally-representative Medicare Current Beneficiary Survey (2000-2013), we will identify the population of elderly Medicare patients with CVD during a 14-year period and evaluate immediate and longer-term changes in their utilization and clinical outcomes following Part D. Study measures will include demographic and clinical attributes, drug and non-drug utilization, cost-related medication nonadherence, acute hospital events, and perceived health status. For the period after Part D implementation, we will develop and examine new measures including patient cost-coping strategies, month-to-month adherence, and out-of-plan purchasing. For high-risk CVD patients (those with drug spending near or above the Part D """"""""donut hole"""""""" coverage gap threshold), we will estimate changes in outcomes following the sudden 2011 improvement in brand name drug coverage within this coverage gap. In particular, we will examine changes in adherence and CVD treatment intensity for Part D patients in or near the coverage gap, by therapeutic drug class and by brand versus generic status.

Public Health Relevance

The effects of Medicare Part D implementation on access to medicines and changes in health services and outcomes are poorly understood for the large population of elderly with cardiovascular disease. Our study aims to investigate changes in these important outcomes in the 8 years following Part D implementation, in particular after a large 2011 discount on branded medicines for patients entering the donut hole coverage gap.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG028745-07
Application #
8530126
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Bhattacharyya, Partha
Project Start
2006-09-15
Project End
2015-05-31
Budget Start
2013-09-01
Budget End
2014-05-31
Support Year
7
Fiscal Year
2013
Total Cost
$339,032
Indirect Cost
$100,112
Name
Harvard Pilgrim Health Care, Inc.
Department
Type
DUNS #
071721088
City
Boston
State
MA
Country
United States
Zip Code
02215
Briesacher, Becky A; Madden, Jeanne M; Zhang, Fang et al. (2015) Did Medicare Part D Affect National Trends in Health Outcomes or Hospitalizations? A Time-Series Analysis. Ann Intern Med 162:825-33
Madden, Jeanne M; Adams, Alyce S; LeCates, Robert F et al. (2015) Changes in drug coverage generosity and untreated serious mental illness: transitioning from Medicaid to Medicare Part D. JAMA Psychiatry 72:179-88
Naci, Huseyin; Soumerai, Stephen B; Ross-Degnan, Dennis et al. (2014) Medication affordability gains following Medicare Part D are eroding among elderly with multiple chronic conditions. Health Aff (Millwood) 33:1435-43
Naci, Huseyin; Soumerai, Stephen B; Ross-Degnan, Dennis et al. (2014) Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011. Med Care 52:951-6
Harrold, Leslie R; Briesacher, Becky A; Peterson, Dan et al. (2013) Cost-related medication nonadherence in older patients with rheumatoid arthritis. J Rheumatol 40:137-43
Blanchard, Janice; Madden, Jeanne M; Ross-Degnan, Dennis et al. (2013) The relationship between emergency department use and cost-related medication nonadherence among medicare beneficiaries. Ann Emerg Med 62:475-85
Harrold, Leslie R; Peterson, Daniel; Beard, Ashley J et al. (2012) Time trends in medication use and expenditures in older patients with rheumatoid arthritis. Am J Med 125:937.e9-15
Nekhlyudov, Larissa; Madden, Jeanne; Graves, Amy Johnson et al. (2011) Cost-related medication nonadherence and cost-saving strategies used by elderly Medicare cancer survivors. J Cancer Surviv 5:395-404
Briesacher, Becky A; Madden, Jeanne M; Soumerai, Stephen B (2011) Caution in generalizing Part D results to Medicare population. Arch Intern Med 171:366-7; author reply 367
Briesacher, Becky A; Zhao, Yanfang; Madden, Jeanne M et al. (2011) Medicare part D and changes in prescription drug use and cost burden: national estimates for the Medicare population, 2000 to 2007. Med Care 49:834-41

Showing the most recent 10 out of 14 publications