Falling into the Doughnut Hole

Patel, Uptal D.; Davis, Matthew M.

doi:10.1681/asn.2005121385

Cited by 20 publications

(11 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty-nine percent of ESRD patients would qualify for catastrophic coverage (mean month, July), compared with only 14% of the general population (mean month, September). 4 These figures are congruent with those produced using Medstat Markets data (above). Analyzing further to look at drug cost variability, Patel found the cost variability from month to month was even greater among ESRD patients than non-ESRD patients, suggesting that ESRD patients with moderate to high drug costs will be more vulnerable to cost swings that may increase their risk of reducing or stopping essential chronic medications.…”

Section: Dialysissupporting

confidence: 77%

“…Again, dialysis is a covered entity, but patients without ESRD must be at least 65 years old to receive Medicare benefits. 4 In this analysis, almost 54% of patients were taking more than 10 medications compared with slightly less than 24% of patients in the general Medicare population. In terms of drug spending, ESRD medications averaged $6,488 + $765 annually, compared with $2,705+$35 in the population without ESRD.…”

Section: Dialysismentioning

confidence: 79%

“…On average, predicted out-of-pocket spending by patients with ESRD under Medicare Part D was $2,329+$133 compared with $1,311 + $16 in patients without ESRD. 4 Patel also predicted that 70% of ESRD patients would reach the gap, with June being the month when this would happen most often compared with 43% of the general Medicare population (the mean month for this group was July). Thirty-nine percent of ESRD patients would qualify for catastrophic coverage (mean month, July), compared with only 14% of the general population (mean month, September).…”

Section: Dialysismentioning

confidence: 99%

See 2 more Smart Citations

Chronic Kidney Disease and Medicare

Peter

2007

JMCP

View full text Add to dashboard Cite

BACKGROUND: Since 1972, Medicare has covered the cost of end-stage renal disease (ESRD). Consequently, Medicare pays a large proportion of ESRD's costs. However, before implementation of Medicare Part D, employer health plans paid most ESRD-associated prescription costs. The ESRD population faces significant hurdles when using the new Part D benefit. To understand those challenges, a basic understanding of Part D is needed.SUMMARY: Medicare Part D has unique implications for chronic kidney disease (CKD) populations (dialysis, kidney transplant, and CKD patients not on dialysis). Approximately 405,000 ESRD patients were eligible for Part D coverage in 2006. Drug coverage is available for many drugs via Medicare Part B or Part D; however, the Medicare Part B and Part D medication coverage divide is confusing to most clinicians, including pharmacists. Many ESRD patients fall into the dual-eligible category-they are covered by both Medicare and Medicaid. These patients now receive their medications through Part D and must enroll in a prescription drug plan (PDP). However, many PDP plans may not have the drugs that were covered in state-sponsored Medicaid programs. Dialysis-specific issues also abound because of the high-cost, high-use medications needed to treat the numerous comorbid conditions (diabetes, hypertension, anemia, bone and mineral metabolism disorders, and cardiovascular disorders) that flourish in the ESRD population.CONCLUSION: Managed care demonstration projects are underway to better understand if enrolling these patients into managed care plans with disease management models (i.e., special needs plans) can provide quality care in an effective and efficient manner. Screening patients at high risk for kidney disease, identifying patients with early kidney disease, preventing progression to ESRD, and effectively managing comorbid conditions may reduce long-term medical costs and maintain work productivity. Health care providers need to make an active effort to help CKD patients select kidney-friendly formularies. Medicare requires medication therapy management (MTM) services for certain beneficiaries (called "targeted beneficiaries") enrolled in PDP plans to improve medication optimization. Approximately 80% of the typical ESRD population has more than 2 targeted comorbidities. Thus, many ESRD patients should be targeted for MTM services, a task that represents an opportunity for pharmacists.J Manag Care Pharm. 2007:13(9):S13-S18

show abstract

Section: Dialysissupporting

confidence: 77%

Section: Dialysismentioning

confidence: 79%

Section: Dialysismentioning

confidence: 99%

See 1 more Smart Citation

Chronic Kidney Disease and Medicare

Peter

2007

JMCP

View full text Add to dashboard Cite

show abstract

“…• 22 used pooled analysis designs (Crystal, Sambamoorthi, Walkup, & Akincigil, 2003;Ettner, Hermann, & Tang, 1999;Fiscella & Holt, 2007;Foote & Hogan, 2001;Hancox et al, 2005;Hill, Fillit, Thomas, & Chang, 2006;Hoover, Crystal, Kumar, Sambamoorthi, & Cantor, 2002;Housman et al, 2003;Kemper, Weaver, Short, Shea, & Kang, 2008;Noyes, Liu, Holloway, & Dick, 2007;Noyes, Liu, Li, Holloway, & Dick, 2006;O'Malley & Forrest, 2006;Patel & Davis, 2006;Rice, Snyder, Kominski, & Pourat, 2002;Riley, Lubitz, & Zhang, 2003;Simoni-Wastila, Zuckerman, Shaffer, Blanchette, & Stuart, 2008;Stuart, Simoni-Wastila, & Chauncey, 2005;Waidmann & Liu, 2000;Wei, Sambamoorthi, Olfson, Walkup, & Crystal, 2005),…”

Section: Resultsmentioning

confidence: 99%

Methodological Issues in Using Multiple Years of the Medicare Current Beneficiary Survey

Briesacher¹,

Tjia²,

Doubeni³

et al. 2011

MMRR

View full text Add to dashboard Cite

Background:The analysis presented in this paper examines the multi-year capacity of the Medicare Current Beneficiary Survey (MCBS). Methods:We systematically reviewed the literature for methodological approaches in research using multiple years of the MCBS and categorized the studies by study design, use of survey sampling weights, and variance adjustments. We then replicated the approaches in an empirical demonstration using functional status (activities of daily living (ADL) and 2005 Results: In the systematic review, we identified 22 pooled, 17 repeated cross-sectional, and 17 longitudinal studies. Less than half of these studies explicitly described the weighting approach or variance estimation. In the empirical demonstration, we showed that different study designs and weighting approaches will yield statistically different estimates. Conclusion:There is a variety of methodological approaches when using multiple years of the MCBS, and some of them provide biased results. Research needs to improve in describing the methods and preferred approaches for using these complex data.Keywords: Medicare current beneficiary survey, Health Care Surveys, Survey design, Survey sampling weight, Systematic review, SAS, SUDAAN doi: http://dx.doi.org/10.5600/mmrr.002.01.a04 Briesacher, B.A., Tjia, J., Doubeni, C.A., Chen, Y., Rao, S.R. E2 INTRODUCTIONThe Medicare Current Beneficiary Survey (MCBS) is the principal national survey for informing and evaluating health policies for the Medicare program. Since 1991, the Centers for Medicare & Medicaid Services have sponsored this survey, at a cost of $14.8 million a year to administer. To date, nearly 300 published studies have used the MCBS for critical research questions, most recently for assessing the nationwide impact of the Medicare prescription drug program (Part D) (Madden, Graves, Ross-Degnan, Briesacher, & Soumerai, 2009;Madden et al., 2008). However, one aspect of the MCBS that is not well known is its capability for short longitudinal analyses of up to 3 years. Unlike many other national surveys, the MCBS collects follow up data on each individual for up to 3 years of observation. Important questions about health-related changes over time can be answered by combining multiple years of the MCBS.However, the longitudinal data structure of the MCBS can also complicate analyses and cause confusion about appropriate research approaches. Research that uses multiple years of MCBS data faces the following issues. First, there is a nontrivial overlap in the MCBS sample each year (approximately 60% from one year to the next). This means that the assumption of statistical independence is violated for many standard analytic approaches. Second, the repeated observations introduce an additional level of clustered data beyond the survey design. The MCBS's multi-staged complex sampling design creates data that are clustered in primary sampling units and strata, and that require special statistical approaches for correct estimation and tests. However, the use of multiple years of the MC...

show abstract

“…1 Annual out-of-pocket spending for drugs among Medicare beneficiaries with ESRD has been estimated to be nearly twice that of the general beneficiary population. 3 Managing the clinical consequences of ESRD requires extensive medication use. ESRD patients undergoing dialysis receive prescriptions for, on average, between 6 and 12 medications at any one time.…”

mentioning

confidence: 99%

Sources of Drug Coverage among Medicare Beneficiaries with ESRD

Howell

Powers

Weinhandl

et al. 2012

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Despite extensive use of prescription medications in ESRD, relatively little is known about the participation of Medicare ESRD beneficiaries in the Part D program. Here, we quantitated the sources of drug coverage among ESRD beneficiaries and explored the Part D plan preferences of ESRD beneficiaries with regard to deductibles, coverage gaps, and monthly premiums. We obtained data on beneficiary sources of creditable coverage, characteristics of Part D plans, demographics, and residence from the Centers for Medicare and Medicaid Chronic Condition Data Warehouse and identified beneficiaries with ESRD from the US Renal Data System. We found that a substantial proportion (17.0%) of ESRD beneficiaries lacked a known source of creditable drug coverage in 2007 and 64.3% were enrolled in Part D. Of those enrolled, 72% received the Medicare Part D low-income subsidy. ESRD beneficiaries who enrolled in standalone Part D plans without the assistance of the low-income subsidy tended to prefer more comprehensive coverage options. In conclusion, more outreach is needed to ensure that beneficiaries who lack coverage obtain the coverage they need and that ESRD beneficiaries join the best plans for managing their disease and accompanying comorbid conditions.

show abstract

Falling into the Doughnut Hole

Cited by 20 publications

References 31 publications

Chronic Kidney Disease and Medicare

Chronic Kidney Disease and Medicare

Methodological Issues in Using Multiple Years of the Medicare Current Beneficiary Survey

Sources of Drug Coverage among Medicare Beneficiaries with ESRD

Contact Info

Product

Resources

About