Regular Research ArticlesIncreases in Medicare Prescription Drug Plan Costs Attributable to Psychotropic Medications
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)
- et al.
Medication characteristics beyond cost alone influence decisions to underuse pharmacotherapy in response to financial pressures
J Clin Epidemiol
(2006) - et al.
Medical comorbidity and late life depression: what is known and what are the unmet needs?
Biol Psychiatry
(2002) - et al.
Comorbidity of late life depression: an opportunity for research on mechanisms and treatment
Biol Psychiatry
(2002) Administration on Aging: Older Adults and Mental Health Issues and Opportunities
(2001)- et al.
Depression and cost-related medication nonadherence in Medicare beneficiaries
Arch Gen Psychiatry
(2007) Undermining Stability. The Plight of Mentally Ill Americans Under the 2006 Medicare Drug Benefit
(2005)Clearing Hurdles and Hitting Walls Restrictions Undermine part D Coverage of Mental Health Drugs
(2006)- et al.
Medication access and continuity: the experiences of dual-eligible psychiatric patients during the first 4 months of the medicare prescription drug benefit
Am J Psychiatry
(2007)
Cited by (0)
Presented at the Nineteenth NIMH Conference on Mental Health Services Research Pre-Conference Workshop for New Investigators, Washington DC, July 2007.