Removal of Drug Coverage Caps Associated With Improved Medication Persistence

Published Dec 20, 2017
Value in Health Report Suggests That Removal of Drug Caps May Lead to Increased Use of Medications and Reduce the Racial Therapy Gap Princeton, NJ—December 20, 2017—Value in Health, the official journal of ISPOR (the professional society for health economics and outcomes research), announced today the publication of a research report suggesting that the removal of drug coverage caps may lead to improved medication persistence and help reduce the racial therapy gap in the United States. The report was published in the December 2017 issue. Patients in the United States who are eligible for both Medicare and Medicaid are the fastest growing segment of the Medicare population. These vulnerable, dual enrollee patients are disproportionately nonwhite and at a higher risk for multiple morbidities. Many state Medicaid programs limit, or place caps on, the number of medications that will be reimbursed per month. In contrast, the Medicare Part D program prohibits the use of limits on the number of medications reimbursed. The article, Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer, describes the authors’ evaluation of a representative 5% national sample of all fee-for-service dual enrollees (Medicaid and Medicare Part D) in the United States (2004–2007). The aim was to investigate the impact of the removal of caps on the number of reimbursable prescriptions per month under Medicare Part D on the prevalence and average days’ supply dispensed for antidepressants, antihypertensives, and lipid-lowering agents overall and by race (white and black). The removal of drug caps was associated with the increased use of lipid-lowering medications overall. Among African American patients in states where the number of prescriptions are capped, the authors observed an increase in the use of lipid-lowering and antidepressant therapies and an increased trend in antihypertensive use; however, black patients used more antihypertentive medications to begin with, so for these medications the increase is primarily due to higher use rates among white patients.The racial disparity (“white-black gap”) in the use of lipid-lowering medications was immediately reduced, and a reversal of the widening racial differences in antihypertensive use was observed. “Patients eligible for both Medicare and Medicaid (dual enrollees) are the fastest growing segment of the Medicare population,” said lead author Alyce S. Adams, PhD, research scientist with the Kaiser Permanente Division of Research, Oakland, CA, USA. “In 2006, the Medicare Modernization Act shifted prescription drug coverage for dual enrollees from Medicaid to privately administered Medicare Part D plans. One key feature of Medicare Part D is that, unlike many state Medicaid programs, Medicare Part D prohibits the use of limits, or caps, on the number of medications reimbursed per month. Exploring the mechanisms by which this and similar changes in coverage affect access to noncancer therapies can inform the development of strategies to maximize the potential for such policies to ensure access to clinically essential services, especially among groups of patients who experience disparities in access because of restricted coverage.”


ABOUT ISPOR ISPOR, the professional society for health economics and outcomes research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field. Web: | LinkedIn: | Twitter: (@ISPORorg) | YouTube: | Facebook: ABOUT VALUE IN HEALTH Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help health care leaders make evidence-based decisions. The journal’s 2016 impact factor score is 4.235. Value in Health is ranked 3rd out of 77 journals in health policy and services, 7th out of 347 journals in economics, and 9th out of 90 journals in health care sciences and services. Value in Health publishes 10 issues a year and circulates to more than 10,000 readers around the world. Web: | Twitter: (@ISPORjournals)

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