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Avalere Study Shows Medicare Part D Helping People with Type 2 Diabetes; Warns People with Diabetes of Probability of Reaching the 'Donut Hole'

WASHINGTON, March 13 /PRNewswire/ -- Medicare Part D has improved drug coverage and lessened the financial burden for many beneficiaries with type 2 diabetes, says a new study released today by Avalere Health at its Forum on Diabetes event.

The study is the first to use a large, national claims dataset to examine the effect of Part D enrollment on drug utilization and out-of-pocket costs for enrollees with type 2 diabetes. In addition to exploring utilization and cost data, the study also shows that the majority of enrollees with type 2 diabetes that reached the coverage gap, or "donut hole," threshold in 2006 did so by August, but this experience did not precipitate a drop in the number of prescriptions filled after that point.

Medicare Part D ushered in sweeping changes to the Medicare program, with the intent of creating affordable access to drug coverage for all seniors, thus improving their ability to purchase necessary prescription drugs and better manage their health. While recent public opinion research has shown high consumer satisfaction with Part D, little quantitative research has been published to test the actual effects of Part D on seniors' out-of-pocket costs and access to drugs.

The new Avalere study pulls back the curtain on the first two years of the drug benefit to see if Part D is meeting its stated policy goals with respect to diabetes. Its findings bode well for people with type 2 diabetes. First, most drugs used to treat diabetes and its two most common co-occurring conditions -- hypertension and dyslipidemia -- are widely covered by Part D health plans, at rates of 85-88 percent, and on tiers 1 and 2 of plan formularies which are associated with the lowest co-payments. By comparison, previous Avalere analysis shows that Part D formularies include an average of 75 percent of antipsychotic drugs and 88 percent of antidepressants, classes of drugs designated by the government as "protected."

Access is also measured via utilization, or how many prescriptions people take, and how much they are spending for those drugs. On both counts, Avalere's report points to improvements for Medicare Part D enrollees with type 2 diabetes. Out-of-pocket diabetes drug costs per prescription were 35 percent lower for standalone prescription drug plan (PDP) enrollees and 25 percent lower for Medicare Advantage prescription drug (MA-PD) plan enrollees, as compared to fellow Medicare beneficiaries who chose not to enroll in Part D. PDP enrollees were taking 11.2 percent more prescriptions and MA-PD enrollees 6.2 percent more prescriptions than before they had Part D coverage.

"Part D is meeting its goals of increasing access to, and affordability of, drugs to Medicare beneficiaries," said Valerie Barton, vice president of Avalere Health and co-author of the study.

A unique aspect of Part D is the coverage gap, or donut hole. To date, there has been much speculation on whether the coverage gap would be a hindrance to continuity of care and access to medications. Avalere found that 43 percent of non-Medicaid beneficiaries with type 2 diabetes enrolled in PDPs and 33 percent enrolled in MA-PDs reached the threshold by the end of 2006. In 2006, the majority who reached that threshold did so by August. But hitting the gap did not correlate with reduced use of prescription drugs, and in fact, the study showed no reduction in the number of prescriptions filled by patients with diabetes.

"Knowing when people with diabetes may hit the coverage gap is important for physicians who can look for signs of non-compliance, and for individuals who can use this data for financial planning purposes," said Barton. "The lack of change in the number of prescription drugs used invites more research on whether patients with type 2 diabetes tend to enroll in Part D plans that offered gap coverage, the financial sensitivity of patients with chronic illness, and generic switching patterns for patients in the coverage gap."

The Avalere study did not evaluate if Medicare drug coverage has translated into improved health for seniors with Medicare drug coverage. According to Barton, this type of research is currently not feasible.

"Regrettably, outcomes research on the Medicare population post-Part D implementation is hindered by the lack of integrated data from Medicare Part A, B, and D. Policymakers should consider the value of this type of integrated medical and pharmacy claims dataset and work fast to make it available to enable a deeper evaluation of Part D's success or shortcomings."

Avalere used its proprietary DataFrame database of Part D plan benefit and formulary designs to characterize access to diabetes-related drugs in Part D and Wolters Kluwer's Source Lx, a nationally representative claims data repository, to analyze drug utilization and out-of-pocket costs from January 1, 2004 through September 30, 2007.

"The Impact of Medicare Part D on Beneficiaries with Type 2 Diabetes: Drug Utilization and Out-of-Pocket Expenses," was authored by Zeynal Karaca, Sonya B. Streeter, Valerie Barton, Khoa Nguyen, and Kris Norris, all of Avalere Health. Takeda Pharmaceuticals North America provided funding for the research. Avalere maintained editorial control and the conclusions expressed in the research paper are solely those of the authors.

SOURCE Avalere Health
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