263354 Medicare Part D plan optimization: The need for an annual check-up

Monday, October 29, 2012 : 10:54 AM - 11:06 AM

Rajul A. Patel, PharmD, PhD , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Mark P. Walberg, PharmD, PhD , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Nataliya McElroy, BS, PharmD Candidate 2013 , Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Anil Mallya, BS, PharmD Candidate 2013 , Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Aesun Kim, PharmD Candidate 2013 , Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Yvonne Mai, PharmD Candidate 2013 , Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Justin Seo, PharmD Candidate 2013 , Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Joseph A. Woelfel, PhD, RPh , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Sian M. Carr-Lopez, PharmD , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Suzanne M. Galal, PharmD , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
  
     
Background: Since its inception, Medicare Part D requires beneficiaries to choose from a myriad of insurance plans in order to receive prescription drug coverage. Moreover, each year beneficiaries are confronted with plan cancellations, new plan offerings, changes in existing plan formularies and cost-sharing structure. Objective: This study prospectively examined the relationship between stand-alone prescription drug plan (PDP) costs, subsidy status, and the number of plans offered in California from 2009-2012. Methods: Forty-one community outreach events were held throughout Central/Northern California during the Medicare Part D annual election periods from 2008-2011. In total, 1,578 beneficiaries were assisted, 983 (62.2%) of whom had a PDP. During each intervention, beneficiary subsidy status, cost data for the beneficiary's current plan and lowest cost plan for the upcoming year were recorded from the Medicare website. The percent of beneficiaries that did not need to switch plans to reduce their out-of-pocket (OOP) drug costs was compared to the number of available plans in the subsequent year.Results: On average, 14.3-23.7% of beneficiaries would have been enrolled in the lowest cost plan in the upcoming year had they remained in their current plan. Subsidy recipients were significantly more likely to be in the lowest cost plan each year. The chance of being in the lowest cost plan was significantly negatively correlated to the number of drug plans offered in the subsequent year.

Conclusion: Annual Part D plan reexamination is essential to ensure that beneficiaries optimize their prescription medication coverage and minimize their OOP costs.

Learning Areas:
Implementation of health education strategies, interventions and programs
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe the relationship between drug plan costs, subsidy status, and plan offerings. Describe the importance of annual plan reexamination and the potential consequences of failure to do so.

Keywords: Medicare, Healthcare Costs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working with Medicare beneficiaries and performing research on Part D since its inception. Since that time I have presented over 30 posters and platform presentations on the topic and have published more than a half-dozen papers in the area of Medicare Part D and beneficiaries. I have also been Principal Investigator on a grant that was specifically aimed at assisting Medicare beneficiaries optimize their Part D plan.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3102.0: Medicare/Medicaid Policy