Early Study of Outcomes From Medicare Part D Can't Explain North-South Disparities
Patients' access to diabetes and heart failure drugs through Medicare
plans in the first two years of the Part D option did not guarantee
proper therapy, researchers at the University
of Maryland (UM) found in
a nationwide study published today
in the journal Health Affairs.
The study revealed that Medicare patients in the northern regions of
the nation spent more for Part D drugs for the two conditions and
tended to adhere better to taking them than did patients in southern
All of the 10 lowest-spending areas were in southern states, and all of
the 10 highest-spending areas were in northern or central states. Of
the 50 lowest-cost regions, 43 were south of the 37th parallel, which
extends roughly from the Virginia-North Carolina border to central
California, and 43 of the 50 highest-cost regions were above that line.
"Is it because of the patients or the physicians?" lead researcher
Bruce Stuart, PhD, asks
rhetorically. "Well, patients can't get the
drugs without the physicians. How well they take the drugs is up to the
patients. We think it is more patient behavior than physician behavior.
We are trying to find out what those factors might be. Why would there
be regional differences in terms of patient behavior?"
Stuart is the Parke-Davis chair in geriatric pharmacotherapy at the UM
School of Pharmacy, executive director of the Peter Lamy Center for
Drug Therapy and Aging, and a professor in the Department of
Pharmaceutical Health Services Research.
Researchers did not find any strong evidence of Medicare savings in
treating diabetes and heart failure--savings such as lower hospital
costs or fewer medical services--as a result of higher Part D spending.
"However, this is only half a story because there are several plausible
conjectures behind these findings," says Stuart. "The (Part D) program
came into play in 2006 and for many of the people who got the benefit,
this could be the first time they were using the drugs." Also, these
drugs are primarily for long-term benefit. "The answer is likely that
it takes a while for these drugs to work," Stuart says.
Stuart says analysis of subsequent years of Part D will be needed to
make firm conclusions as to the payoff in hospital costs and services
for people using and adhering to the heart and diabetes drugs regimens.
Stuart hopes to begin a follow-up study to replicate the first
For the first study, Stuart and his team analyzed a 5 percent random
sample of the Medicare population from a database compiled by the
Centers for Medicare and Medicaid Services. They chose heart failure
and diabetes because managing those chronic conditions is heavily
dependent on drugs, they are very common chronic diseases, and the
drugs have been proved effective in clinical trials.
Stuart says the study team formed two preliminary "bottom lines."
First, although the researchers couldn't find much difference in who
was taking the drugs, they clearly found that among people who used
them, regimen adherence was higher in the north and that made drug
spending higher. "Then we asked, 'Do people who are spending more and having higher adherence have lower spending on Part A and Part B
services to treat diabetes and heart failure?'" Stuart explains. The
researchers did not see that relationship, but when they looked at
total Medicare costs, they found that regions in the South with lower
adherence had higher average Medicare spending for all A and B services
compared to northern regions.
"Discovering which regional factors are responsible for differences in
medication practices should be a high priority," the researchers wrote
in Health Affairs.
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