Regular Research Articles
Increases in Medicare Prescription Drug Plan Costs Attributable to Psychotropic Medications

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Objective

Older patients may regard some medications, particularly psychotropic medications, as discretionary compared with what they perceive as more “essential” nonpsychiatric medications. Patients' concerns about psychotropic medication costs under Medicare Part D may reinforce these impressions.

Design

The authors examined which Medicare prescription drug plans (PDPs) would be least expensive for beneficiaries considering the costs of 1) all medications; and 2) only nonpsychiatric medications.

Setting

The authors collected data from the PDP online comparison tool provided by the Centers for Medicare and Medicaid Services (CMS).

Participants

Hypothetical Medicare beneficiaries.

Measurements

The authors examined four clinical scenarios from older outpatients with both chronic medical and psychiatric conditions (including psychosis, bipolar disorder, depression, and dementia with behavioral disturbances).

Results

The authors examined data from all 160 plans available in CMS PDP regions in May 2007. There were frequent discrepancies in the least expensive PDPs within region, depending on considering the costs of all medications, or just nonpsychiatric medications. In the clinical scenarios, patients selecting a PDP based on nonpsychiatric medications alone would pick an unnecessarily more expensive plan 74%–100% of the time (when they took any brand name medication), suggesting that excluding psychiatric medications from PDP choices may be excessively costly. However, brand name psychotropic medications significantly increased the costs of the least expensive plans. The latter finding might persuade patients to avoid taking needed psychiatric medication due to cost.

Conclusion

This research highlights the complexity that patients with psychiatric and cognitive disorders face when choosing a Medicare PDP. Policymakers and clinicians should be aware of the tradeoffs that beneficiaries with psychiatric disorders face when making PDP plan choices.

Section snippets

Data Sources

Information on the PDPs and their annual costs for each of the patient scenarios was collected through the CMS Medicare Prescription Drug Plan Finder (MPDPF) (http://www.medicare.gov/MPDPF/Home.asp) on May 7th, 2007. In each patient care scenario, the three medication lists (all medications, psychiatric medications, and nonpsychiatric medications) were submitted to the MPDPF for each of the 34 defined Medicare PDP regions.11, 12 For purposes of Part D insurance plans, the 50 states and

RESULTS

Although there were 160 separate potential PDP plans available across the regions, the optimal plans for the clinical scenarios included only 13 PDP carriers and 21 distinct PDPs. We found substantive differences in the estimated costs and affordability of Medicare PDPs for beneficiaries, based on their prescription drug regimens and regions of residence. We describe our findings case by case below, and present Fig. 1 illustrating the incomplete information penalty by case.

DISCUSSION

Medicare beneficiaries are likely to consider the costs of medications when choosing PDP plans,11 and may use the same web-based tool that we used to compare options of plans under different medication regimens. Not only is there variation across regions regarding lowest cost PDPs, but there is substantial variation in optimal plan choice based on which set of medications are considered in a patient treatment regimen.

It was striking to find that, when brand name psychiatric medications are

LIMITATIONS

This study demonstrates how sensitive lowest cost PDPs are to specific medication lists. Therefore, a prescribing physician could treat a patient with similar clinical conditions as patients in these four scenarios, and by choosing different medications within a drug class, the price of both the medications and the lowest cost PDPs could vary substantially. Therefore, one should make generalizations about the costs of treatment and PDPs for these conditions with caution.

Furthermore, this study

CONCLUSIONS

This research highlights the complexity and potential burden that patients with psychiatric and cognitive disorders face when determining which Medicare PDP to choose. Policymakers and clinicians should be aware of these tradeoffs that beneficiaries with psychiatric disorders face when making PDP choices. Use of generic medications when possible, particularly for psychiatric disorders, will decrease patient costs, may allow them to use multiple medications for all disorders within a plan

APPENDIX: TABLES 2–5 COLUMN DEFINITIONS

Region: For purposes of Part D insurance plans, the 50 states plus DC are divided into34 PDP regions. Regions may include one or more states.

All Meds: The annual cost of all the medications, both psychiatric and non-psychiatric, according to the CMS Medicare Prescription Drug Plan Finder (MPDPF), using the Part D insurance provider in each PDP region that results in the lowest overall cost to the patient for all of the medications listed for the case (see Fig. 1). This cost includes Part D

References (17)

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Presented at the Nineteenth NIMH Conference on Mental Health Services Research Pre-Conference Workshop for New Investigators, Washington DC, July 2007.

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