An overview and study of beneficiaries' knowledge, attitudes, and perceptions of the medicare part d benefit.

PURPOSE: Medicare beneficiaries' knowledge, attitudes, and perceptions (KAP) of the Medicare Part D prescription drug benefit have been under evaluation since the 2006 inception of the Part D benefit. OBJECTIVE: This study sought to examine beneficiaries' satisfaction with their Medicare Part D prescription drug plan, knowledge of the coverage gap, attitudes about the relative importance of certain insurance parameters, and overall perceptions of the Part D benefit. DESIGN: Cross-sectional, descriptive study design. SETTING: Thirteen outreach events targeting Medicare beneficiaries in northern California during the 2012 open-enrollment period. PARTICIPANTS: A total of 576 Medicare beneficiaries. INTERVENTIONS: Beneficiaries were asked questions related to their KAP of the Part D benefit as part of a plan to evaluate their need for assistance. Sociodemographic data were collected via a standardized survey. MAIN OUTCOME MEASURES: Identify variances in KAP related to beneficiary sociodemographic and clinical characteristics. RESULTS: Forty-seven percent of beneficiaries claimed to be "very" or "extremely" satisfied with Part D, yet only 40.3% of those with a prescription drug plan (PDP) rated their plan as "very good" or "excellent." Those automatically enrolled into their plan by Medicare were significantly less satisfied with their plan (P = 0.048). Almost three in four recipients not receiving Medicare subsidies have heard of the gap in prescription drug coverage, i.e., the "donut hole." Additionally, there were significant racial disparities in knowledge of the gap. Only 62.7% of beneficiaries indicated that "total out-of-pocket cost during the year" was the most important plan characteristic for them. CONCLUSIONS: An understanding of beneficiaries' attitudes may help explain suboptimal Part D plan selection. Moreover, evaluating beneficiaries' knowledge of the Part D benefit can assist advocacy groups in creating educational materials to better assist this vulnerable population in choosing an appropriate plan.

Assessing quality of life in an ambulatory medicare population.

OBJECTIVE: Medicare beneficiaries have unique health-related challenges causing significant impact on quality of life. This study examined the overall health-related quality of life (HRQOL) and differences in HRQOL between subgroups of an ambulatory Medicare beneficiary population. METHODS: Nine outreach events were held during the 2011 Medicare Part D prescription drug open-enrollment period, in which 397 beneficiaries were assisted with Part D plan evaluation and comprehensive medication therapy review. Demographic data were collected, and the SF-36v2 was administered to measure beneficiaries' self-reported HRQOL. Correlations were assessed between the mental component summary (MCS) or physical component summary (PCS) scores of the SF-36v2, prescription utilization, number of chronic conditions, and whether beneficiaries were government subsidy recipients. RESULTS: Mean Å standard deviation of PCS and MCS scores were 43.3 Å 11.4 and 52.2 Å 11.7, respectively. Both PCS and MCS scores were negatively correlated with the number of prescription medications and number of self-reported chronic conditions. Both PCS and MCS scores related to sociodemographics were significantly lower (P < 0.05) in subsidy and least-educated recipients. CONCLUSIONS: HRQOL can vary widely as a result of sociodemographic, drug, or disease differences in an ambulatory Medicare beneficiary population.

Potential opportunity cost of neglecting to annually reassess Medicare Part D standalone prescription drug plan offerings: the price of contentment?

OBJECTIVES: To determine the (1) potential cost difference (opportunity cost [OC]) to Medicare-eligible beneficiaries enrolled in the lowest-cost standalone prescription drug plan (PDP) in 2007 between the cost of such plan in 2008 and the lowest-cost plan in 2008 and the (2) percentage of PDPs with the lowest estimated annual cost (EAC) in both 2007 and 2008. DESIGN: Descriptive exploratory study. SETTING: United States during 2007 and 2008. PATIENTS: 50 patients were randomly selected from a database of Medicare-eligible beneficiaries. INTERVENTION: Pharmacy claims records for each study patient were obtained during the period January 1 to June 30, 2007. Patient medication profiles were generated using these data and entered into the Medicare Plan Finder Tool (www.medicare.gov) to obtain the EAC of each PDP from 2007 and 2008 in all 34 Medicare Part D regions. MAIN OUTCOME MEASURES: The 2008 EAC of the lowest-cost PDP from 2007 was recorded. OC was determined by subtracting the 2008 EAC of the lowest-cost PDP in 2008 from the 2008 EAC of the lowest-cost PDP in 2007 for each patient in each region. The percentage of PDPs that had the lowest EAC in both 2007 and 2008 was recorded. RESULTS: The 2008 EACs of the lowest-cost PDPs from 2007 were significantly higher (P < 0.001) than the lowest-cost PDPs of 2008 within all 34 Medicare regions. The mean OC ranged from $276 to $562 nationally. Only 12% of plans were the lowest-cost PDP in both 2007 and 2008. CONCLUSION: Medicare beneficiaries should reevaluate PDP offerings annually during the open enrollment period; failure to do so may increase avoidable out-of-pocket costs.

Analysis of national annual variation in total patient out-of-pocket Medicare Part D stand-alone prescription drug plan costs from 2007 to 2008.

OBJECTIVE: This is the first study to compare total Medicare Part D (MPD) stand-alone prescription drug plan (PDP) estimated annual costs (EAC) between 2007 and 2008 in all MPD regions of the US using a patient cohort of Medicare-eligible patients. METHODS: A total of 50 patients were selected at random from a database of Medicare-eligible patients. Each patient profile, based on pharmacy claims data, was entered into the Medicare website and the EAC of each PDP in each of the 34 MPD regions was obtained. The lowest, 25th percentile, median and highest EAC plans were obtained for each patient in each region for 2007 and 2008. Pair-wise, within-region, between-year comparisons were made using the Wilcoxon Signed-Ranks test. RESULTS: Annual trends were variable between MPD regions. Only the highest EAC showed significant decreases in some regions, while all other comparisons showed no change or an increase in regional costs. CONCLUSIONS: Out-of-pocket Medicare prescription drug costs increased from 2007 to 2008. Increases in plan costs highlight the need for annual re-evaluation of PDP costs so that the patient is able to obtain the lowest cost plan each year. The decrease in the highest cost plan may suggest improvements in formulary coverage.

Cost variability of suggested generic treatment alternatives under the Medicare Part D benefit.

BACKGROUND: The substitution of generic treatment alternatives for brand-name drugs is a strategy that can help lower Medicare beneficiary out-of-pocket costs. Beginning in 2011, Medicare beneficiaries reaching the coverage gap received a 50% discount on the full drug cost of brand-name medications and a 7% discount on generic medications filled during the gap. This discount will increase until 2020, when beneficiaries will be responsible for 25% of total drug costs during the coverage gap. OBJECTIVE: To examine the cost variability of brand and generic drugs within 4 therapeutic classes before and during the coverage gap for each 2011 California stand-alone prescription drug plan (PDP) and prospective coverage gap costs in 2020 to determine the effects on beneficiary out-of-pocket drug costs. METHODS: Equivalent doses of brand and generic drugs in the following 4 pharmacological classes were examined: angiotensin II receptor blockers (ARBs), bisphosphonates, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). The full drug cost and patient copay/coinsurance amounts during initial coverage and the coverage gap of each drug was recorded based on information retrieved from the Medicare website. These drug cost data were recorded for 28 California PDPs. RESULTS: The highest cost difference between a brand medication and a Centers for Medicare Medicaid Services (CMS)-suggested generic treatment alternative varied between $110.53 and $195.49 at full cost and between $51.37 and $82.35 in the coverage gap. The lowest cost difference varied between $38.45 and $76.93 at full cost and between -$4.11 and $18.52 during the gap. CONCLUSION: Medicare beneficiaries can realize significant out-of-pocket cost savings for their drugs by taking CMS-suggested generic treatment alternatives. However, due to larger discounts on brand medications made available through recent changes reducing the coverage gap, the potential dollar savings by taking suggested generic treatment alternatives during the gap is less compelling and will decrease as subsidies increase.

Assessing Medicare beneficiaries' willingness-to-pay for medication therapy management services.

OBJECTIVES: To assess Medicare beneficiaries' willingness-to-pay (WTP) for medication therapy management (MTM) services and determine sociodemographic and clinical characteristics influencing this payment amount. DESIGN: A cross-sectional, descriptive study design was adopted to elicit Medicare beneficiaries' WTP for MTM. SETTING: Nine outreach events in cities across Central/Northern California during Medicare's 2011 open-enrollment period. PARTICIPANTS: A total of 277 Medicare beneficiaries participated in the study. INTERVENTIONS: Comprehensive MTM was offered to each beneficiary. Pharmacy students conducted the MTM session under the supervision of licensed pharmacists. At the end of each MTM session, beneficiaries were asked to indicate their WTP for the service. Medication, self-reported chronic conditions, and beneficiary demographic data were collected and recorded via a survey during the session. RESULTS: The mean WTP for MTM was $33.15 for the 277 beneficiaries receiving the service and answering the WTP question. WTP by low-income subsidy recipients (mean ± standard deviation; $12.80 ± $24.10) was significantly lower than for nonsubsidy recipients ($41.13 ± $88.79). WTP was significantly (positively) correlated with number of medications regularly taken and annual out-of-pocket drug costs. CONCLUSION: The mean WTP for MTM was $33.15. WTP for MTM significantly varied by race, subsidy status, and number of prescription medications taken. WTP was significantly higher for nonsubsidy recipients than subsidy recipients, and significantly positively correlated with the number of medications regularly taken and the beneficiary rating of the delivered services.

Medicare Part D roulette: potential implications of random assignment and plan restrictions.

BACKGROUND: Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown. OBJECTIVE: We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan. METHODS: Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary's medications on plan formulary) were calculated for each benchmark plan. RESULTS: Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions. CONCLUSIONS: Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance.

Impact of an elective course on pharmacy students' attitudes, beliefs, and competency regarding Medicare Part D.

OBJECTIVE: To determine the impact of an elective course on pharmacy students' perceptions, knowledge, and confidence regarding Medicare Part D, medication therapy management (MTM), and immunizations. DESIGN: Thirty-three pharmacy students were enrolled in a Medicare Part D elective course that included both classroom instruction and experiential training. ASSESSMENT: Students' self-reported confidence in and knowledge of Part D significantly improved upon course completion. End-of-course student perceptions about the relative importance of various aspects of MTM interventions and their confidence in performing MTM services significantly improved from those at the beginning of the course. Students' confidence in performing immunizations also increased significantly from the start of the course. CONCLUSION: A classroom course covering Medicare Part D with an experiential requirement serving beneficiaries can improve students' attitudes and knowledge about Medicare Part D and their confidence in providing related services to beneficiaries in the community.

Use of potentially inappropriate medications in an ambulatory Medicare population.

OBJECTIVE: To determine the prevalence of potentially inappropriate medication (PIM) use by applying the Beers criteria in an ambulatory population of Medicare beneficiaries, and to identify the most common PIMs/PIM classes taken by this population. DESIGN: Cross-sectional, observational study. SETTING: Nine community outreach events throughout central and northern California. PATIENTS: 295 ambulatory Medicare beneficiaries (65 to 98 years of age). INTERVENTIONS: Pharmacy students, under the supervision of licensed pharmacists, assisted beneficiaries with Medicare Part D plan enrollment and medication review, including identification of PIMs. MAIN OUTCOME MEASURES: Number of PIMs taken by beneficiaries and the most frequent PIMs/PIM classes. RESULTS: 54 (18.3%) beneficiaries were taking at least one PIM. The most common PIMs taken by the study group were alprazolam, clonidine, and estrogen. The two most common classes of such medications were benzodiazepines and antiarrhythmics. CONCLUSION: Many older adults continue to receive medications that should be avoided because of limited effectiveness and/or potential for harm. Prescribers and pharmacists must be diligent in ensuring that medications given to older adults are necessary and appropriate. Outreach events targeting seniors provide an ideal forum to identify and address such issues.