Some of the first analyses on the impact of Medicare Part D, as well as new insights on drug adherence patterns by chronic disease patients, have been presented at the 2010 AcademyHealth Annual Meeting by several University of Maryland, Baltimore (UMB) teams of pharmaceutical health services researchers.
Although the Medicare Prescription Drug, Improvement, and Modernization Act, known as Part D, became law Jan. 1, 2006, records were previously under a federal moratorium and not available to researchers until the Centers for Medicare and Medicaid Services (CMS) released 2006 and 2007 records late in 2009. "Now future data will be more timely," said Bruce Stuart, PhD, a professor and executive director of the Peter Lamy Center on Drug Therapy and Aging in the School of Pharmacy (SOP) at UMB.
Stuart says that he and other Lamy Center researchers are busy tracking, analyzing, and reporting on medication adherence patterns emerging from Part D data.
Here are some of their findings:
In the first study of its kind, a team of researchers led by Stuart found strong statistical evidence that a low-income subsidy (LIS) element of Part D appears to be performing well. The LIS was designed to help low-income people qualified for Medicare to pay for some or all of their monthly Part D premiums and substantially reduces required co-insurance and co-pays.From records of 151,460 diabetics who were enrolled in Medicare for all of 2006, the study revealed that those benefiting from the LIS had similar therapy adherence as those without the LIS. "To be eligible, you have to have income below 135 percent of the poverty line and few assets," said Stuart. "So, you would expect lower adherence from this group. The subsidy lowers drug co-pays and protects beneficiaries from the coverage gap known as the 'doughnut hole.' We found that adherence patterns for LIS enrollees were very similar to higher-income beneficiaries without the subsidy. In other words, LIS appears to be doing what it was supposed to."
"Another UMB team analyzed Medicare records of nearly 120,000 retirees with congestive heart failure (CHF) who had employer-sponsored Medicare supplemental plans. The researchers said their findings can lead to new interventions to keep the patients faithful to their medication regimens. Sarah Dutcher, PhD student, and Ilene Zuckerman, PharmD, PhD, professor and chairwoman for the SOP's Department of Pharmaceutical Health Services Research (PHSR), said that overall, Medicare beneficiaries with supplemental insurance and prescription drug coverage did adhere well to their CHF medications. However, retirees with additional medical conditions, such as depression, dementia, peripheral vascular disease, and chronic obstructive pulmonary disease, had poor adherence to their CHF medications.
Another team led by Stuart found that Medicare costs for older people with diabetes can be reduced if they initiate diabetes drugs sooner. The team analyzed the 2006 and 2007 drug use patterns of nearly 250,000 Medicare beneficiaries diagnosed with diabetes. Those with a longer duration of oral anti-diabetic drugs and related medications had lower Medicare costs. The study addressed a serious problem that 30 percent or more of people whose doctors prescribe drugs for a chronic condition fail to fill or postpone filling their first prescription. Such nonadherence raises the risk of "avoidable adverse health events," said Stuart.
A UMB study of chronic obstructive pulmonary disease (COPD) patients revealed that those who stay true to their prescribed maintenance therapy save Medicare an average of 20 percent annually compared to COPD patients who do not consistently take their maintenance medications. Maintenance drugs are a mainstay in preventing costly and disabling COPD exacerbations, including hospitalizations. The study, led by Linda Simoni-Wastila, BSPharm, PhD, a professor in PHSR, is based on panel data from the 1997 to 2005 Medicare Current Beneficiary Surveys. The study team compared maintenance therapy users and nonusers of recommended maintenance medications on selected clinical and economic outcomes for a nationally representative sample of Medicare beneficiaries with COPD. Annually, only 40 percent filled any prescriptions for COPD maintenance medications, 57 percent were hospitalized, and, of those initially hospitalized, 19 percent suffered a re-hospitalization. COPD beneficiaries who were older, female, and with prescription drug coverage experienced lower costs, while those with more co-morbidities and poor health status experienced higher costs.
"A study presented by Xuehua Ke, PhD candidate, and Amy Davidoff, PhD, an associate professor in PHSR, found a large and disproportionate financial burden was experienced by elderly and disabled, community-dwelling fee-for-service Medicare beneficiaries with cancer. In 2006, there were 7.5 million beneficiaries, or 17 percent, reported having ever received a cancer diagnosis. For those self-reporting a cancer diagnosis in 2006, out-of-pocket burden for medical care and prescription drugs (beyond primary and supplemental coverage) was higher for those with lower income levels, higher for those with worse health status, higher for those without medical supplemental coverage, and higher for those having Part D with no LIS. The medium out-of-pocket spending, excluding premiums, relative to income was 8 percent for beneficiaries with cancer.
Another study of diabetics, headed by Jennifer Lloyd, PhD student, showed that patients with less knowledge about the disease have less persistent use of antidiabetic drugs and statins. Prior studies focused on the influence of drug prices on adherence. The UMB team looked at whether knowledge of the disease, attitudes, and other health behaviors influenced medication adherence. They confirmed that disease-specific and other preventive health behaviors were significant predictors of adherence behaviors but there was not a consistent pattern between the three drug types studied. The researchers recommended that policymakers consider behavioral and attitudinal variables associated with medication use, persistent use, and levels of use to identify groups that might be less likely to stay adherent.
In a study of Medicare beneficiaries with hypertension, presented by PhD candidate Masayo Sato, monthly changes in non-hypertension medication 'pill burden' had little effect on adherence to their hypertension drugs, suggesting that drug regimens that increase patients' daily number of pill counts may not be expected to adversely affect adherence to anti-hypertensive medications.
The Peter Lamy Center serves as the focal point for research, education, and service in geriatric pharmacotherapy at the University of Maryland and is dedicated to improving drug therapy for aging adults through a growing array of innovative programs.