Medicare Drug Coverage’s Effects on Care Quality

Having drug coverage is viewed as important because it increases the likelihood of adherence to prescribed treatments, since cost is a major reason for medication non-adherence, and drug adherence may reduce use in other categories if the drugs improve health status.  So theoretically, adding benefits for prescription drugs to Medicare should have shown some significant effect on certain health status or quality of care measures or use of other categories of care.  Research published in the Annals of Internal Medicine suggests this may not have been the case.  (AIM Article)   The researchers used a sample of over 55,000 Medicare beneficiaries with survey data from 2000 to 2010.  Part D started in 2006, so this allowed a before and after comparison.  Several studies have suggested that Part D enrollment did indeed increase adherence.  The data included self-reported health outcomes and status, use of certain categories of service such as ER and inpatient hospital, and certain socio-economic factors.

The survey results confirmed that very few Medicare beneficiaries, only around 5%, have no drug coverage following enactment of Part D.  In the five years after enactment, however, there was no change in the number of beneficiaries reporting fair or poor health or reporting a limitation in the activities of daily living.  Similarly ER use and hospital use and spending were unchanged.  The study should lead to caution in making assumptions that greater access to drugs lowers other areas of health use or spending; an approach which the Congressional Budget Office has potentially mistakenly just adopted.  The study may be weakened by its use of self-reported data, but these do have value, and the authors ran confirmatory analyses using Medicare claims data.  Bet the drug companies aren’t too happy with this research.