Impact of Medicare supplement coverage on access, utilization, and cost of health care and on compliance with recommended pharmaceutical treatment

Research Objectives: The literature was reviewed to determine the impact of Medicare Supplement (i.e., Medigap) coverage on the Medicare program with respect to access, utilization, outcomes, costs, and drug compliance. Additionally, we discuss a new program to improve pharmaceutical utilization for Medigap insureds.

Study Design: We conducted a literature search using PubMed, looking for peer-reviewed articles that compared access, utilization, outcomes and costs between those with Medicare fee-for-service coverage alone to those with Medigap. Additional searches focused on differences in pharmacological compliance, for those with and without drug coverage, among the two groups. Finally, we searched for pharmacy compliance programs offered through Medigap plans.

Population Studied: 27 articles met our search criteria.

Principle Findings: The literature suggests Medigap coverage can be cost-effective, that it is correlated with better access to health care services, and may result in higher utilization of preventive services than would be the case without such coverage. Also, the type of supplement coverage did not significantly influence prescription drugs utilization among Medicare insureds. No articles found discussed any current efforts to manage the pharmaceutical treatment of Medigap insureds.

Conclusion: Medigap programs have not historically managed their insureds like Medicare Advantage plans have done. In particular, the literature suggests there is much room for improvement in pharmacy management for all Medicare populations, including those enrolled in Medigap plans. This has led UnitedHealth Group to offer a pharmacological compliance program, with disease management and case management programs, for their AARP Medigap insureds, beginning in 2009. Results from this care management effort will help tailor models to better manage the care for fee-for-service Medicare insureds with supplement coverage.