Adverse Selection In The Medicare Prescription Drug Program

Riley, Gerald F.; Levy, Jesse M.; Montgomery, Melissa A.

doi:10.1377/hlthaff.28.6.1826

Cited by 17 publications

(18 citation statements)

References 5 publications

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“…First, the fee-for-service service beneficiaries for which we have more complete prescription and encounter data may not be representative of the entire US older adult population. 27 Second, pharmacy claims data do not contain information about the condition the drug is intended to treat, so our matching of encounters and prescriptions may have measurement bias or be affected by trends in coding practice. 28,29 In addition, we were not able to classify approximately 18% of antibiotic claims as appropriate or inappropriate because they had no associated diagnoses, similar to a previous study 30 that found that 15% of Medicare antibiotic claims had no associated encounter.…”

Section: Discussionmentioning

confidence: 99%

Trends in outpatient antibiotic prescribing practice among US older adults, 2011-2015: an observational study

Olesen

Barnett

MacFadden

et al. 2018

Preprint

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Structured abstractObjective: To identify temporal trends in outpatient antibiotic use and antibiotic prescribing practice among older adults.Design: Observational study using United States Medicare administrative claims during [2011][2012][2013][2014][2015]. Trends in antibiotic use were estimated using multivariable regression adjusting for beneficiaries' demographic and clinical covariates. Setting: Medicare.Participants: 4.6 million Medicare beneficiaries from a nationwide, 20% sample of fee-forservice Medicare beneficiaries ³65 years old. Main outcome measurements:Overall rates of antibiotic prescription claims, rates of appropriate and inappropriate prescribing, rates for each of the most frequently prescribed antibiotics, and rates of antibiotic claims associated with specific diagnoses.Results: Antibiotic claims fell from 1362.2 to 1361.6 claims per 1,000 beneficiaries per year during 2011-2015, an overall 0.2% decrease (95% CI 0.07-0.32). Inappropriate antibiotic claims fell from 552 to 533 claims per 1,000 beneficiaries, a 4.1% decrease (CI 3.9-4.3). Individual antibiotics had heterogeneous changes in use. For example, azithromycin claims per beneficiary decreased by 18.4% (CI 18.2-18.7) while levofloxacin claims increased by 28.1% (CI 27.5-28.6).. CC-BY-ND 4.0 International license It is made available under a (which was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint . http://dx.doi.org/10.1101/292243 doi: bioRxiv preprint first posted online Mar. 31, 2018; 3 Azithromycin use associated with each of the potentially appropriate and inappropriate respiratory diagnoses we considered decreased, while levofloxacin use associated with each of those diagnoses increased. Conclusion

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Section: Discussionmentioning

confidence: 99%

Trends in outpatient antibiotic prescribing practice among US older adults, 2011-2015: an observational study

Olesen

Barnett

MacFadden

et al. 2018

Preprint

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“…Because Part D plan choice is voluntary, it is possible that relatively healthy beneficiaries select into an MA-PD. 27 Propensity score matching partially accounts for this possibility by ensuring similar distributions in observable characteristics between the 2 groups being compared. 28,29 We calculated each beneficiary's propensity score of enrolling in an MA-PD plan based on logistic regression.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Statin Adherence Among Beneficiaries in MA-PD Plans Versus PDPs

Jung¹,

McBean

Kim

2012

JMCP

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• Medicare Part D services are delivered through 2 different types of private plans: Medicare Advantage prescription drug (MA-PD) plans or stand-alone prescription drug plans (PDPs). MA-PD plans cover both drug therapy and other medical services, whereas PDPs provide prescription drug coverage only. • An economic model suggests that an optimal level of medication use, which maximizes consumers' utility or benefit, will be achieved when one insurer is responsible for covering all types of substitutable services. Observational studies have suggested that pharmacy therapy and nondrug medical services may be substitutable. Goldman et al. (2006) found that medication possession ratio (MPR) of less than 80% for statin therapy was associated with increases in hospitalizations and emergency room visits. Gibson et al. (2006) reported that MPR greater than 80% for statin therapy was related to fewer coronary heart disease-related hospitalizations, all-cause hospitalizations, and emergency room visits.• These findings suggest that health plans that cover both drug and medical services may have an incentive to improve medication adherence in an attempt to reduce medical costs. MA-PD plans offer more generous drug benefits than do PDPs. However, little is known about whether Medicare beneficiaries in MA-PD plans, which cover different types of substitutable services, have better medication adherence than those in PDPs. What is already known about this subjectComparison of Statin Adherence Among Beneficiaries in MA-PD Plans Versus PDPs Kyoungrae Jung, PhD; A. Marshall McBean, MD, MSc; and Jee-Ae Kim, MPP ABSTRACT BACKGROUND: Medicare Part D, which provides prescription drug coverage to Medicare beneficiaries, is delivered through either Medicare Advantage prescription drug (MA-PD) plans or stand-alone prescription drug plans (PDPs). MA-PD plans cover both drug therapy and other medical services, whereas PDPs provide prescription drug coverage only. Because of the potential substitutability between prescription drugs and other medical services, MA-PD plans may make greater efforts to improve enrollees' adherence to recommended medications than PDPs. Prescription drug benefits are more generous in MA-PD plans than in PDPs.

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“…Lastly, for PCTs that require data on use of outpatient prescription drugs, another gap in Medicare data that needs to be considered is that only 60% of beneficiaries receive their drug coverage through Medicare Part D [57]. Part D enrollees tend to be poorer and less healthy than their counterparts with alternate drug coverage [58]. …”

Section: Using Administrative Data For More Efficient and Effectivmentioning

confidence: 99%

Improving the efficiency and effectiveness of pragmatic clinical trials in older adults in the United States

Saag¹,

Mohr

Esmail

et al. 2012

Contemporary Clinical Trials

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Pragmatic clinical trials (PCTs) seek to improve the generalizability and increase the statistical power of traditional explanatory trials. They are a major tenet of comparative effectiveness research. While a powerful study design, PCTs have been limited by high cost, modest efficiency, and limited ability to fill relevant evidence gaps. Based on an American Reinvestment and Recovery Act (ARRA) supported meeting of national stakeholders, we propose several innovations and future research that could improve the efficiency and effectiveness of such studies focused in the U.S. Innovations discussed include optimizing the use of community based practices through partnership with Practice Based Research Networks (PBRNs), using information technology to simplify PCT subject recruitment, consent and randomization processes, and utilizing linkages to large administrative databases, such as Medicare, as a mechanism to capture outcomes and other important PCT variables with lower subject and research team burden. Testing and adaptation of such innovations to PCT are anticipated to improve the public health value of these increasingly important studies.

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Adverse Selection In The Medicare Prescription Drug Program

Cited by 17 publications

References 5 publications

Trends in outpatient antibiotic prescribing practice among US older adults, 2011-2015: an observational study

Trends in outpatient antibiotic prescribing practice among US older adults, 2011-2015: an observational study

Comparison of Statin Adherence Among Beneficiaries in MA-PD Plans Versus PDPs

Improving the efficiency and effectiveness of pragmatic clinical trials in older adults in the United States

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