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Previous Volume 361:52-61 July 2, 2009 Number 1 Next

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ABSTRACT

Background It is not known what effect the increased use of prescription drugs by enrollees in Medicare Part D has had on spending for other medical care.

Methods We compared spending for prescription drugs and other medical care 2 years before the implementation of Part D in January 2006 with such expenditures 2 years after the program's implementation in four groups of elderly beneficiaries: Medicare Advantage enrollees with stable, uncapped, employer-based drug coverage throughout the study period (no-cap group), those who had no previous drug coverage, and those who had previous limited benefits (with either a $150 or a $350 quarterly cap) before they were covered by Part D in 2006.

Results Between December 2005 and December 2007, as compared with the increase in the no-cap group, the increase in total monthly drug spending was $41 higher (95% confidence interval [CI], $33 to $50) (74%) among enrollees with no previous drug coverage, $27 higher (95% CI, $20 to $34) (27%) among those with a previous $150 quarterly cap, and $13 higher (95% CI, $8 to $18) (11%) among those with a previous $350 cap. The use of both lipid-lowering and antidiabetic medications rose in the groups with no or minimal previous drug coverage. As compared with expenditures in the no-cap group, monthly medical expenditures (excluding drugs) were $33 lower (95% CI, $29 to $37) in the group with no previous coverage and $46 lower (95% CI, $29 to $63) in the group with a previous $150 quarterly cap, whereas medical spending was $30 higher (95% CI, $25 to $36) in the group with a previous $350 cap.

Conclusions Enrollment in Medicare Part D was associated with increased spending on prescription drugs. Groups that had no or minimal drug coverage before the implementation of Part D had reductions in other medical spending that approximately offset the increased spending on drugs, but medical spending increased in the group that had more generous previous coverage.

Source Information

From the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh (Y.Z., J.M.D., J.R.L.); and Highmark (G.O.) — both in Pittsburgh; the Department of Health Care Policy, Harvard Medical School, and the Department of Health Policy and Management, Harvard School of Public Health — both in Boston (J.P.N.); and the Harvard Kennedy School, Harvard University, Cambridge, MA (J.P.N.).

Address reprint requests to Dr. Donohue at the Department of Health Policy and Management, University of Pittsburgh, 130 De Soto St., Crabtree Hall 613, Pittsburgh, PA 15261, or at jdonohue{at}pitt.edu.

Full Text of this Article

This article has been cited by other articles:

• (2009). Medicare Part D, Prescription Drug Spending, and Total Medical Spending. Journal Watch Cardiology 2009: 1-1 [Full Text]