Annals of Long Term Care

American Medical Directors Association Long-Term Care Medicine 2010
Long Beach, CA; March 11-14, 2010

Poster

The Effect of Medicare Part D on Patients with Parkinson’s Disease
Long Beach, CA--It is estimated that 3% of the U.S. population age 65 and over are affected by Parkinson's disease (PD). Many patients with PD are enrolled in Medicare Part D (MPD), a prescription drug coverage program for seniors established by the Medicare Modernization Act of 2003. The Standard Benefit of Part D includes a gap in coverage, commonly known as the doughnut hole (DH). The DH can introduce risks in prescription coverage due to increased out-of-pocket costs for patients during the coverage gap. Additional information on the impact of the MPD program and the DH on prescription drug utilization and behavior is needed to continue to inform policy.

Researchers M.L. Tarrants and J. Castelli-Haley, Teva Neuroscience, Kansas City, MO, and T. Shea and M.F. Denarie, IMS Health, Plymouth Meeting, PA, utilized longitudinal prescription transaction records from the IMS Lifelink (LRx) database, which captures over 64% of all retail prescriptions and contains information on 150 million unique patients. Prescription claims data from January 1, 2008, to December 31, 2008, were obtained. Subjects included in the analysis were patients with PD age 65 years and older classified as a study group of Part D Standard Benefit or a Commercially Insured control group. Part D patients were determined to have the Standard Benefit based on patient copayment amounts relative to drug costs.

93,041 patients with PD were selected, 28% of whom were identified as Part D Standard Benefit, and 72% of whom were identified as Commercial. Annual drug spend for the two groups was categorized by the 2008 MPD guidelines: patients who did not reach the DH (< $2510); patients who reached the DH but not Catastrophic Coverage ($2510 to $5726); or patients who reached Catastrophic Coverage (> $5726).

The percentage of patients with spend < $2510 was significantly greater in the Commercial group (65% vs 49%; P < 0.05). The percentage of patients with spend between $2510 to $5726 was significantly greater in the Standard Benefit Group (38% vs 22%; P < 0.05). Patients in both groups with spend between $2510 to $5726 had similar discontinuation (12%) and switching (9%) rates, while Standard Benefit patients reduced concomitant therapy at a slightly higher rate (2% vs 1%). The proportion of patients with spend >$5726 was the same in both groups (13%), and market compliance was similar between the groups.

51% of the Standard Benefit patients reached the DH, and over half reached it by July. Of these patients, 74% remained in the DH, while only 26% reached catastrophic coverage. Therefore, 13% (3.5k/26k) of the Part D Standard Benefit patients reached Catastrophic Coverage, which is much lower than the 38% anticipated. Lastly, Standard Benefit patients in the DH reduced spending by $44/month more than their control group. This reduction in spending impacted their PD spending (-$11/mo) but also impacted their decisions to fill prescriptions for comorbidities at a greater rate (-$33/mo).

The Part D Standard Benefit group had a higher percentage of patients with annual spend in the DH range than the control group. Also, a much lower percentage of Standard Benefit patients than originally expected are making it through the DH to the Catastrophic Coverage level. Patients in the DH are forced to reduce spending and make difficult decisions, such as to treat or not to treat their neurodegenerative disease (ie, PD) in addition to other comorbid conditions.