A controversial component of the Medicare Prescription Drug Benefit (Part D) enacted in 2006 is the """"""""doughnut hole"""""""", a gap in coverage for pharmacy expenditures between $2,250 and $5,100. We recently reported that one in four seniors entered the doughnut hole in 2006 and reduced their number of prescribed medications by 14% per month after entering it.1 Cost-related medication non-adherence can worsen health outcomes, lead to higher rates of hospitalization, and increase overall medical care spending.2, 3 The coverage gap may be particularly detrimental to Medicare beneficiaries with chronic mental disorders such as major depression, bipolar disorder, and schizophrenia, but we know almost nothing about how they respond to the coverage gap. We will use merged national Medicare pharmacy and medical data to evaluate changes in medication use and clinical outcomes before and after entering the doughnut hole, among beneficiaries with three mental disorders. We then use the estimated effect to assess the most cost-effective approaches to covering psychotropic medications in the doughnut hole. We will compare approaches that involve: a) covering generic psychotropic drugs, b) covering all psychotropic drugs for a certain subpopulation, and c) reducing the size of the doughnut hole. Findings from our study will provide critical information for policy makers to redesign Part D benefits or value-based insurance design in general. Equipped with this information, in addition, clinicians and care givers can anticipate the adverse effects of the doughnut hole and proactively work together with patients to develop alternative regimens. Major depression, bipolar disorder and schizophrenia are costly and disabling illnesses, which affect over 15% of Medicare beneficiaries and cost $165 billion annually in the US. Over half of Medicare beneficiaries with these mental disorders spent more than $2,250 on pharmacy expenditures in 2006, and many were fully exposed to the coverage gap under current Medicare Part D benefit design. We propose to assess the most cost- effective, potentially cost-saving, methods to pay for psychotropic medications for these beneficiaries entering the coverage gap.

Public Health Relevance

Major depression, bipolar disorder and schizophrenia are costly and disabling illnesses, which affect over 15% of Medicare beneficiaries and cost $165 billion annually in the US. Over half of Medicare beneficiaries with these mental disorders spent more than $2,250 on pharmacy expenditures in 2006, and many were fully exposed to the coverage gap under current Medicare Part D benefit design. We propose to assess the most cost- effective, potentially cost-saving, methods to pay for psychotropic medications for these beneficiaries entering the coverage gap.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
NIH Challenge Grants and Partnerships Program (RC1)
Project #
1RC1MH088510-01
Application #
7818901
Study Section
Special Emphasis Panel (ZRG1-HDM-A (58))
Program Officer
Rupp, Agnes
Project Start
2009-09-30
Project End
2011-08-31
Budget Start
2009-09-30
Budget End
2010-08-31
Support Year
1
Fiscal Year
2009
Total Cost
$499,106
Indirect Cost
Name
University of Pittsburgh
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Hernandez, Inmaculada; Zhang, Yuting; Brooks, Maria M et al. (2017) Anticoagulation Use and Clinical Outcomes After Major Bleeding on Dabigatran or Warfarin in Atrial Fibrillation. Stroke 48:159-166
Kaplan, Cameron M; Zhang, Yuting (2017) Anticipatory Behavior in Response to Medicare Part D's Coverage Gap. Health Econ 26:338-351
Driessen, Julia; Baik, Seo Hyon; Zhang, Yuting (2016) Trends in Off-Label Use of Second-Generation Antipsychotics in the Medicare Population From 2006 to 2012. Psychiatr Serv 67:898-903
Zhang, Yuting; Talisa, Victor; Baik, Seo Hyon (2015) Part D Plan Switching Among Medicare Beneficiaries With Schizophrenia. Psychiatr Serv 66:1105-8
Zhang, Yuting; Baik, Seo Hyon; Newhouse, Joseph P (2015) Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings. Health Aff (Millwood) 34:455-60
Zhang, Yuting; Zhou, Chao; Baik, Seo Hyon (2014) A simple change to the Medicare Part D low-income subsidy program could save $5 billion. Health Aff (Millwood) 33:940-5
Zhang, Yuting; Baik, Seo Hyon (2014) Race/Ethnicity, disability, and medication adherence among medicare beneficiaries with heart failure. J Gen Intern Med 29:602-7
Zhang, Yuting; Kaplan, Cameron M; Baik, Seo Hyon et al. (2014) Medication adherence and readmission after myocardial infarction in the Medicare population. Am J Manag Care 20:e498-505
Kaplan, Cameron; Zhang, Yuting (2014) The January effect: medication reinitiation among Medicare Part D beneficiaries. Health Econ 23:1287-300
Zhang, Yuting; Wu, Shang-Hua; Fendrick, A Mark et al. (2013) Variation in medication adherence in heart failure. JAMA Intern Med 173:468-70

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