Entering and Exiting the Medicare Part D Coverage Gap: Role of Comorbidities and Demographics
| Autor: | Norman Turk, Carol M. Mangione, Susan L. Ettner, Neil Steers, O. Kenrik Duru, Julie A. Schmittdiel, Elaine Quiter |
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| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Gerontology
Male Financing Personal Demographics Adverse outcomes Medicare Part D Comorbidity Insurance Coverage 03 medical and health sciences 0302 clinical medicine Assurance maladie Medicine & Public Health Health insurance Internal Medicine health care costs Medicine health economics Humans 030212 general & internal medicine Aged Demography Aged 80 and over Health economics business.industry 030503 health policy & services Health services research Health economy health services research United States 3. Good health Logistic Models medicare health insurance Chronic Disease Original Article Female Health Expenditures 0305 other medical science business |
| Zdroj: | Journal of General Internal Medicine Ettner, SL; Steers, N; Duru, OK; Turk, N; Quiter, E; Schmittdiel, J; et al.(2010). Entering and exiting the medicare part D coverage gap: Role of comorbidities and demographics. Journal of General Internal Medicine, 25(6), 568-574. doi: 10.1007/s11606-010-1300-6. UCLA: Retrieved from: http://www.escholarship.org/uc/item/1hr4z38k Ettner, Susan L.; Steers, Neil; Duru, O. Kenrik; Turk, Norman; Quiter, Elaine; Schmittdiel, Julie; et al.(2010). Entering and Exiting the Medicare Part D Coverage Gap: Role of Comorbidities and Demographics. Journal of General Internal Medicine, 25(6), pp 568-574. doi: 10.1007/s11606-010-1300-6. Retrieved from: http://www.escholarship.org/uc/item/5rz4t76p |
| ISSN: | 1525-1497 0884-8734 2005-2006 |
| DOI: | 10.1007/s11606-010-1300-6. |
| Popis: | Background: Some Medicare Part D enrollees whose drug expenditures exceed a threshold enter a coverage gap with full cost-sharing, increasing their risk for reduced adherence and adverse outcomes. Objective: To examine comorbidities and demographic characteristics associated with gap entry and exit. Design: We linked 2005-2006 pharmacy, outpatient, and inpatient claims to enrollment and Census data. We used logistic regression to estimate associations of 2006 gap entry and exit with 2005 medical comorbidities, demographics, and Census block characteristics. We expressed all results as predicted percentages. PATIENTS: 287,713 patients without gap coverage, continuously enrolled in a Medicare Advantage Part D (MAPD) plan serving eight states. Patients who received a low-income subsidy, could not be geocoded, or had no 2006 drug fills were excluded. Results: Of enrollees, 15.9% entered the gap, 2.6% within the first 180 days; among gap enterers, only 6.7% exited again. Gap entry was significantly associated with female gender and all comorbidities, particularly dementia (39.5% gap entry rate) and diabetes (28.0%). Among dementia patients entering the gap, anti-dementia drugs (donepezil, memantine, rivastigmine, and galantamine) and atypical antipsychoticmedications (risperidone, quetiapine, and olanzapine) together accounted for 40% of pre-gap expenditures. Among diabetic patients, rosiglitazone accounted for 7.2% of pre-gap expenditures. Having dementia was associated with twice the risk of gap exit. Conclusions: Certain chronically ill MAPD enrollees are at high risk of gap entry and exposure to unsubsidized medication costs. Clinically vulnerable populations should be counseled on how to best manage costs through drug substitution or discontinuation of specific, non-essential medications. © 2010 Society of General Internal Medicine. |
| Databáze: | OpenAIRE |
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