Table 5.
The Impact of Medicare Part D on Dual‐Eligibles
| Citation | Study Population | Data Sources | Drug Utilization Outcomes | Out‐of‐Pocket Cost Outcomes |
|---|---|---|---|---|
| Longitudinal data | ||||
| Basu, Yin, and Alexander (2010) | Dual‐eligibles from 45 states, aged 65–78 years, compared to near‐elderly patients with Medicaid coverage aged 60–63 (N = 177,331) | Administrative (pharmacy claims, Census 2000), January 2005–April 2007 | No significant changes in trends in the dual‐eligibles’ pill‐days or total number of prescription due to Part D | No significant changes in trends in the dual‐eligibles’ out‐of‐pocket (OOP) expenditures due to Part D |
| Domino and Farley (2010) | Medicare beneficiaries enrolled during 2005–2006 (panel 10); compared to 2004–2005 (panel 9) (N = 5,015) | Survey (Medical Expenditure Panel Survey), 2004–2006 | Insignificant differences between panels, indicating Part D likely not associated with changes in access to protected psychotropic drug classes (antidepressant and antipsychotic medications) and nonpsychotropic classes (lipid‐lowering and antihypertensive agents) | — |
| Madden et al. (2015) | Community‐dwelling nonelderly disabled dual enrollees with schizophrenia or bipolar disorder who live in “strict‐cap” states with low limits on monthly fills, compared to those living in “no‐cap” states (N = 9,229) | Administrative (Medicaid and Medicare claims), from 2004 to 2007 | Compared to changes in “no‐cap” states, enrollees in “strict‐cap” states with schizophrenia and bipolar disorder had 17.7 and 35.5% increases in overall medication use after Part D | — |
| Millett et al. (2010) | Dual‐eligibles ≥65 with drug coverage in both years but provided through Medicaid in 2005 and Part D in 2006 (N = 198) | Survey (Medical Expenditure Panel Survey), 2005–2006 | — | No significant decrease in mean OOP expenditures among dual‐eligibles or beneficiaries with drug coverage in both years |
| Cross‐sectional data | ||||
| Hensley (2012) | Beneficiaries in Midwestern urban area with mental illness, describing post–Part D experiences; compared to pre–Part D (N = 26) | Qualitative interviews in psychosocial rehabilitation clubhouses, December 2007 to January 2008 | Part D participants perceived that their medication needs (psychotropic and other) were met and did not experience serious access problems during the transition | Mixed opinions about whether the OOP costs for Part D were reasonable or a significant burden preventing them from obtaining other necessities |