Report on Medicare Part D

J0337294As the Medicare Part D experience completed its first year, there have been a number of opinions expressed on how well the benefit did what it set out to do – provide seniors with a benefit on prescription drug access. 

Recently I came across a report by IMS – a company with the purpose of bringing evidence-based intelligence to companies about the pharmaceutical and healthcare markets – that focused on several aspects of Medicare Part D and how it performed.  The report, aptly titled "Medicare Part D:  The First Year" covers several aspects including where the Medicare Part D beneficiaries came from (previously insured, uninsured, etc) as well as providing a look at the types of prescriptions that were filled.

Testimony to the scope and size of the benefit, the report states that Medicare Part D enrollees represented about 15% of the total retail prescriptions filled, or about 486 million prescriptions. 

I was particularly interested in the effect of the so-called "donut hole" – or the gap in coverage that was built into the plan when beneficiaries had reached a certain level of usage – $2250.  What the report found was that only 6% of the Part D beneficiaries were affected and 61%, because they were dual-eligible beneficiaries or were low-income, were not subject to the rule.  One-third of the beneficiaries never reached the $2250 threshold.  Many of those who did hit the threshold did so at the end of the year, but the study also reveals that for those who did hit the donut hole early, it did not seem to affect their utilization of prescriptions.  Unfortunately, the report did not state how many went on to use the catastrophic coverage that kicks in after one satisfies the donut-hole spending level.  Still, the information in the report is quite interesting.

Because it collects so much data, IMS is a company that is well positioned to provide evidence-based analyses of prescriptive patterns.   This report provides an interesting baseline and hopefully future reports from this source will provide greater insight in the future. 

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