Medicare Part D Cost-Sharing and Treatment of Mental Disorders Among Disabled Dua

Summary

Principal Investigator: Julie Marie Donohue
Abstract: DESCRIPTION (provided by applicant): Social Security Disability Income (SSDI) and Medicare are important social insurance programs for adults with severe and persistent mental illnesses. Mentally ill, disabled Medicare beneficiaries who are dually eligible for Medicaid are in poor health, have very low incomes, and high pharmacy utilization. When the Medicare drug benefit (Part D) was implemented in January 2006, 6 million dually eligible beneficiaries transitioned from Medicaid to Medicare drug coverage. Most dually eligible disabled beneficiaries were exposed to an increase in prescription drug cost-sharing following this change in financing. The cost-sharing increase was enacted in spite of a growing body of evidence showing that demand for maintenance medications to treat chronic conditions is highly sensitive to cost-sharing, and that reductions in medication use lead to increases in other health care utilization that offset much of the "savings" in pharmacy expenditures. We plan to study the effects of the Medicare Part D cost-sharing policy on treatment patterns and costs for dually eligible beneficiaries with mental disorders. The objectives of this study are to examine the impact of the increased co-payments on (1) prescription drug utilization and expenditure patterns, and (2) patterns in health service utilization and expenditures among dually eligible beneficiaries with mental disorders. We will use Part D's implementation as a natural experiment to study the effects of cost-sharing changes. We will employ a difference-in-differences methodology that relies on a unique administrative dataset from a health plan that contracts with both Medicare and Medicaid to provide health services to low-income populations. The long-term objective of the proposed work is to inform federal and state pharmaceutical cost-containment policies for low-income beneficiaries with mental disorders. Should we find that Part D prescription drug co-payments lead to treatment discontinuations or reduced refill adherence and increased services use, Medicare policy makers may choose to exempt certain drug classes or beneficiaries from co-payment policies. Relevance to public health. Prescription drugs are a critical component of evidence-based care for most mental disorders. The implementation of the new Medicare drug benefit represents a major change in the financing of prescription drugs for individuals with mental disorders who are dually eligible for Medicare and Medicaid. It is critical to understand the ways in which increased cost-sharing for beneficiaries transitioning from Medicaid to Medicare drug coverage will affect utilization of psychotropic and other prescription drugs as well as health outcomes.
Funding Period: -------------------- - --------------------
more information: NIH RePORT

Top Publications

  1. pmc Generic initiation and antidepressant therapy adherence under Medicare Part D
    Yuhua Bao
    402 E 67th St, New York, NY 10065 E mail
    Am J Manag Care 19:989-98. 2013
  2. pmc Prevalence of potentially preventable unplanned hospitalizations caused by therapeutic failures and adverse drug withdrawal events among older veterans
    Zachary A Marcum
    Department of Medicine Geriatrics, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
    J Gerontol A Biol Sci Med Sci 67:867-74. 2012
  3. pmc Ethnic disparities in adherence to antihypertensive medications of medicare part D beneficiaries
    Holly M Holmes
    Department of General Internal Medicine, UT MD Anderson Cancer Center, Houston, Texas 77030, USA
    J Am Geriatr Soc 60:1298-303. 2012
  4. pmc Medicare Part D and potentially inappropriate medication use in the elderly
    Julie M Donohue
    Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
    Am J Manag Care 18:e315-22. 2012
  5. pmc Use of antipsychotics among older residents in VA nursing homes
    Walid F Gellad
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, USA
    Med Care 50:954-60. 2012
  6. pmc The effect of race-ethnicity on the comparative effectiveness of clozapine among Medicaid beneficiaries
    Marcela Horvitz-Lennon
    RAND Corporation, Pittsburgh, PA 15213, USA
    Psychiatr Serv 64:230-7. 2013
  7. pmc How quickly do physicians adopt new drugs? The case of second-generation antipsychotics
    Haiden A Huskamp
    Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA
    Psychiatr Serv 64:324-30. 2013
  8. pmc Trends in use of high-risk medications for older veterans: 2004 to 2006
    Mary Jo V Pugh
    South Texas Veterans Health Care System, Veterans Evidence Based Research and Implementation Center, San Antonio, Texas 78023, USA
    J Am Geriatr Soc 59:1891-8. 2011
  9. pmc Analgesic use for knee and hip osteoarthritis in community-dwelling elders
    Zachary A Marcum
    Department of Medicine Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Pain Med 12:1628-36. 2011
  10. pmc A review of the effectiveness of antidepressant medications for depressed nursing home residents
    Richard D Boyce
    Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
    J Am Med Dir Assoc 13:326-31. 2012

Scientific Experts

Detail Information

Publications35

  1. pmc Generic initiation and antidepressant therapy adherence under Medicare Part D
    Yuhua Bao
    402 E 67th St, New York, NY 10065 E mail
    Am J Manag Care 19:989-98. 2013
    ..A second objective is to assess how the effect might be moderated by the Medicare Part D coverage gap...
  2. pmc Prevalence of potentially preventable unplanned hospitalizations caused by therapeutic failures and adverse drug withdrawal events among older veterans
    Zachary A Marcum
    Department of Medicine Geriatrics, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
    J Gerontol A Biol Sci Med Sci 67:867-74. 2012
    ..Conclusions. TF-related unplanned hospitalizations occur more frequently than ADWE-related admissions among older Veterans. Almost all TFs and/or ADWEs are potentially preventable...
  3. pmc Ethnic disparities in adherence to antihypertensive medications of medicare part D beneficiaries
    Holly M Holmes
    Department of General Internal Medicine, UT MD Anderson Cancer Center, Houston, Texas 77030, USA
    J Am Geriatr Soc 60:1298-303. 2012
    ..To determine the level of adherence to medications and characteristics of Part D beneficiaries associated with higher levels of antihypertensive medication adherence...
  4. pmc Medicare Part D and potentially inappropriate medication use in the elderly
    Julie M Donohue
    Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
    Am J Manag Care 18:e315-22. 2012
    ..Inappropriate medication use, which is common in older adults, may be responsive to out-of-pocket costs. We examined the impact of Medicare Part D on inappropriate medication use among Medicare beneficiaries...
  5. pmc Use of antipsychotics among older residents in VA nursing homes
    Walid F Gellad
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, USA
    Med Care 50:954-60. 2012
    ..Because little is known about their use in Veterans Affairs (VA) nursing homes [ie, Community Living Centers (CLCs)], we assessed the prevalence and risk factors for antipsychotic use in older residents of VA CLCs...
  6. pmc The effect of race-ethnicity on the comparative effectiveness of clozapine among Medicaid beneficiaries
    Marcela Horvitz-Lennon
    RAND Corporation, Pittsburgh, PA 15213, USA
    Psychiatr Serv 64:230-7. 2013
    ..This study examined the effectiveness by race-ethnicity of clozapine relative to other antipsychotics among adult patients in maintenance antipsychotic treatment...
  7. pmc How quickly do physicians adopt new drugs? The case of second-generation antipsychotics
    Haiden A Huskamp
    Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA
    Psychiatr Serv 64:324-30. 2013
    ..The authors examined physician adoption of second-generation antipsychotic medications and identified physician-level factors associated with early adoption...
  8. pmc Trends in use of high-risk medications for older veterans: 2004 to 2006
    Mary Jo V Pugh
    South Texas Veterans Health Care System, Veterans Evidence Based Research and Implementation Center, San Antonio, Texas 78023, USA
    J Am Geriatr Soc 59:1891-8. 2011
    ....
  9. pmc Analgesic use for knee and hip osteoarthritis in community-dwelling elders
    Zachary A Marcum
    Department of Medicine Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Pain Med 12:1628-36. 2011
    ..To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA)...
  10. pmc A review of the effectiveness of antidepressant medications for depressed nursing home residents
    Richard D Boyce
    Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
    J Am Med Dir Assoc 13:326-31. 2012
    ..Despite a significant increase in the rate of antidepressant prescribing over the past several decades, little is known about the effectiveness of these agents in the NH population...
  11. pmc Medication use and functional status decline in older adults: a narrative review
    Emily P Peron
    Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania, USA
    Am J Geriatr Pharmacother 9:378-91. 2011
    ..A decline in function can increase health care use, worsen quality of life, threaten independence, and increase the risk of mortality. One of several risk factors for decline in functional status is medication use...
  12. pmc Angiotensin-converting enzyme inhibitor and statin use and incident mobility limitation in community-dwelling older adults: the Health, Aging and Body Composition study
    Shelly L Gray
    School of Pharmacy, University of Washington, Seattle, Washington 98195, USA
    J Am Geriatr Soc 59:2226-32. 2011
    ..To evaluate whether the use of angiotensin-converting enzyme (ACE) inhibitors and statins is associated with a lower risk of incident mobility limitation in older community dwelling adults...
  13. pmc Impact of Medicare Part D on antidepressant treatment, medication choice, and adherence among older adults with depression
    Julie M Donohue
    Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA
    Am J Geriatr Psychiatry 19:989-97. 2011
    ..Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice, and adherence...
  14. pmc Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans
    Zachary A Marcum
    Departments of Geriatrics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA
    J Am Geriatr Soc 60:34-41. 2012
    ....
  15. pmc Sources of regional variation in Medicare Part D drug spending
    Julie M Donohue
    Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
    N Engl J Med 366:530-8. 2012
    ....
  16. pmc The financial burden from prescription drugs has declined recently for the nonelderly, although it is still high for many
    Walid F Gellad
    Pittsburgh Veterans Affairs VA Medical Center, Pittsburgh, Pennsylvania, USA
    Health Aff (Millwood) 31:408-16. 2012
    ....
  17. pmc Improving the pharmacologic management of pain in older adults: identifying the research gaps and methods to address them
    M Cary Reid
    Division of Geriatrics and Gerontology, Weill Cornell Medical Center, 525 East 68th Street, Box 39, New York, NY 10065, USA
    Pain Med 12:1336-57. 2011
    ..Specific emphasis was placed on ascertaining gaps regarding use of opioid and nonsteroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits...
  18. pmc Exposure to potentially harmful drug-disease interactions in older community-dwelling veterans based on the Healthcare Effectiveness Data and Information Set quality measure: who is at risk?
    Mary Jo V Pugh
    Veterans Evidence based Research and Implementation CenterGeriatrics and Extended Care, South Texas Veterans Health Care System, San Antonio, Texas 78229, USA
    J Am Geriatr Soc 59:1673-8. 2011
    ..To identify prevalence and risk factors for exposure to drug-disease interactions included in the Healthcare Effectiveness Data and Information Set (HEDIS) Drug-Disease Interaction (Rx-DIS) measure...
  19. pmc Potential underuse, overuse, and inappropriate use of antidepressants in older veteran nursing home residents
    Joseph T Hanlon
    Geriatric Research, Education and Clinical Center, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
    J Am Geriatr Soc 59:1412-20. 2011
    ..To examine prevalence and resident- and site-level factors associated with potential underuse, overuse, and inappropriate use of antidepressants in older Veterans Affairs (VA) Community Living Center (CLC) residents...
  20. pmc Medication misadventures in the elderly: a year in review
    Zachary A Marcum
    Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
    Am J Geriatr Pharmacother 8:77-83. 2010
    ..This paper reviews recent articles examining medication misadventures that can be defined as medication errors and adverse drug events in the elderly...
  21. ncbi What types of inappropriate prescribing predict adverse drug reactions in older adults?
    Joseph T Hanlon
    Department of Medicine Geriatrics, University of Pittsburgh, Pittsburgh, PA 15213, USA
    Ann Pharmacother 44:1110-1. 2010
    ..Besides discussing the strengths and weaknesses of this article, we also recommend future research directions in this area...
  22. pmc Antidepressant prescribing in US nursing homes between 1996 and 2006 and its relationship to staffing patterns and use of other psychotropic medications
    Joseph T Hanlon
    Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
    J Am Med Dir Assoc 11:320-4. 2010
    ..Few studies have examined factors associated with antidepressant prescribing in older nursing home residents...
  23. pmc Interventions to improve suboptimal prescribing in nursing homes: A narrative review
    Zachary A Marcum
    Department of Medicine Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Am J Geriatr Pharmacother 8:183-200. 2010
    ..Appropriate medication prescribing for nursing home residents remains a challenge...
  24. pmc A cross-sectional analysis of the prevalence of undertreatment of nonpain symptoms and factors associated with undertreatment in older nursing home hospice/palliative care patients
    Keri L Rodriguez
    Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
    Am J Geriatr Pharmacother 8:225-32. 2010
    ..Currently, there is limited information on nonpain symptoms and their appropriate treatment in this setting at the end of life...
  25. pmc The quality of warfarin prescribing and monitoring in Veterans Affairs nursing homes
    Sherrie L Aspinall
    Veterans Affairs Center for Medication Safety, Hines, Illinois, USA
    J Am Geriatr Soc 58:1475-80. 2010
    ..To describe the quality of warfarin prescribing and monitoring in Veterans Affairs (VA) nursing homes and to assess the factors associated with maintaining a therapeutic international normalized ratio (INR)...
  26. pmc Ambulatory antibiotic use and prescription drug coverage in older adults
    Yuting Zhang
    Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Crabtree Hall, Room A664, Pittsburgh, PA 15261, USA
    Arch Intern Med 170:1308-14. 2010
    ..However, no studies have evaluated how antibiotic use changes with drug coverage. We evaluate changes in ambulatory oral antibiotic use after implementation of the Medicare drug benefit (Part D)...
  27. pmc Managing medications in clinically complex elders: "There's got to be a happy medium"
    Michael A Steinman
    Division of Geriatrics, University of California, San Francisco, and the San Francisco VA Medical Center, San Francisco, California 94121, USA
    JAMA 304:1592-601. 2010
    ..It also describes a systematic approach for how health professionals can assess and improve medication regimens to benefit patients and their caregivers and families...
  28. ncbi Health reform and the scope of benefits for mental health and substance use disorder services
    Rachel L Garfield
    Department of Health Policy and Management, University of Pittsburgh, 130 De Soto St, Crabtree A612, Pittsburgh, PA 15261, USA
    Psychiatr Serv 61:1081-6. 2010
    ....
  29. ncbi The impact of national health care reform on adults with severe mental disorders
    Rachel L Garfield
    Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, USA
    Am J Psychiatry 168:486-94. 2011
    ..The authors examined current and predicted sources of insurance coverage and use of mental health services among adults with and without severe mental disorders and modeled postreform changes...
  30. pmc Do geriatric conditions increase risk of adverse drug reactions in ambulatory elders? Results from the VA GEM Drug Study
    Michael A Steinman
    Division of Geriatrics, Department of Medicine, University of California, San Francisco, and San Francisco VA Medical Center, San Francisco, CA 94121, USA
    J Gerontol A Biol Sci Med Sci 66:444-51. 2011
    ..Many clinicians prescribe cautiously to older adults with common geriatric conditions for fear of causing adverse drug reactions (ADRs). However, little is known about the association between these conditions and risk of ADRs...
  31. pmc Potentially inappropriate prescribing of primarily renally cleared medications for older veterans affairs nursing home patients
    Joseph T Hanlon
    Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
    J Am Med Dir Assoc 12:377-83. 2011
    ..Inappropriate prescribing of primarily renally cleared medications in older patients with kidney disease can lead to adverse outcomes...
  32. pmc Year in review: medication mishaps in the elderly
    Emily P Peron
    Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
    Am J Geriatr Pharmacother 9:1-10. 2011
    ..This paper reviews articles from 2010 that examined medication mishaps (ie, medication errors and adverse drug events [ADEs]) in the elderly...
  33. pmc Collaborative depression care management and disparities in depression treatment and outcomes
    Yuhua Bao
    Department of Public Health, Weill Cornell Medical College, New York, NY 10065, USA
    Arch Gen Psychiatry 68:627-36. 2011
    ..Collaborative depression care management (DCM), by addressing barriers disproportionately affecting patients of racial/ethnic minority and low education, may reduce disparities in depression treatment and outcomes...