Associations between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles with HIV

Nadya Belenky, Brian W. Pence, Stephen R. Cole, Stacie B. Dusetzina, Andrew Edmonds, Jonathan Oberlander, Michael W. Plankey, Adebola Adedimeji, Tracey E. Wilson, Jennifer Cohen, Mardge H. Cohen, Joel E. Milam, Elizabeth Golub, Adaora A. Adimora

Research output: Contribution to journalArticle

Abstract

Background: The implementation of Medicare part D on January 1, 2006 required all adults who were dually enrolled in Medicaid and Medicare (dual eligibles) to transition prescription drug coverage from Medicaid to Medicare part D. Changes in payment systems and utilization management along with the loss of Medicaid protections had the potential to disrupt medication access, with uncertain consequences for dual eligibles with human immunodeficiency virus (HIV) who rely on consistent prescription coverage to suppress their HIV viral load (VL). Objective: To estimate the effect of Medicare part D on self-reported out-of-pocket prescription drug spending, AIDS Drug Assistance Program (ADAP) use, antiretroviral adherence, and HIV VL suppression among dual eligibles with HIV. Methods: Using 2003-2008 data from the Women's Interagency HIV Study, we created a propensity score-matched cohort and used a difference-in-differences approach to compare dual eligibles' outcomes pre-Medicare and post-Medicare part D to those enrolled in Medicaid alone. Results: Transition to Medicare part D was associated with a sharp increase in the proportion of dual eligibles with self-reported out-of-pocket prescription drug costs, followed by an increase in ADAP use. Despite the increase in out-of-pocket costs, both adherence and HIV VL suppression remained stable. Conclusions: Medicare part D was associated with increased out-of-pocket spending, although the increased spending did not seem to compromise antiretroviral therapy adherence or HIV VL suppression. It is possible that increased ADAP use mitigated the increase in out-of-pocket spending, suggesting successful coordination between Medicare part D and ADAP as well as the vital role of ADAP during insurance transitions.

Original languageEnglish (US)
Pages (from-to)47-53
Number of pages7
JournalMedical Care
Volume56
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Medicare Part D
Anti-HIV Agents
Health Expenditures
Viral Load
HIV
Medicaid
Prescription Drugs
Medicare
Propensity Score
Drug Costs
Insurance
Prescriptions

Keywords

  • ADAP
  • AIDS Drug Assistance Program
  • antiretroviral therapy
  • dual eligible
  • HIV
  • Medicaid
  • Medicare part D

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Belenky, N., Pence, B. W., Cole, S. R., Dusetzina, S. B., Edmonds, A., Oberlander, J., ... Adimora, A. A. (2018). Associations between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles with HIV. Medical Care, 56(1), 47-53. https://doi.org/10.1097/MLR.0000000000000843

Associations between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles with HIV. / Belenky, Nadya; Pence, Brian W.; Cole, Stephen R.; Dusetzina, Stacie B.; Edmonds, Andrew; Oberlander, Jonathan; Plankey, Michael W.; Adedimeji, Adebola; Wilson, Tracey E.; Cohen, Jennifer; Cohen, Mardge H.; Milam, Joel E.; Golub, Elizabeth; Adimora, Adaora A.

In: Medical Care, Vol. 56, No. 1, 01.01.2018, p. 47-53.

Research output: Contribution to journalArticle

Belenky, N, Pence, BW, Cole, SR, Dusetzina, SB, Edmonds, A, Oberlander, J, Plankey, MW, Adedimeji, A, Wilson, TE, Cohen, J, Cohen, MH, Milam, JE, Golub, E & Adimora, AA 2018, 'Associations between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles with HIV', Medical Care, vol. 56, no. 1, pp. 47-53. https://doi.org/10.1097/MLR.0000000000000843
Belenky, Nadya ; Pence, Brian W. ; Cole, Stephen R. ; Dusetzina, Stacie B. ; Edmonds, Andrew ; Oberlander, Jonathan ; Plankey, Michael W. ; Adedimeji, Adebola ; Wilson, Tracey E. ; Cohen, Jennifer ; Cohen, Mardge H. ; Milam, Joel E. ; Golub, Elizabeth ; Adimora, Adaora A. / Associations between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles with HIV. In: Medical Care. 2018 ; Vol. 56, No. 1. pp. 47-53.
@article{5d1bf06789d24d91a5fd7776f897db48,
title = "Associations between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles with HIV",
abstract = "Background: The implementation of Medicare part D on January 1, 2006 required all adults who were dually enrolled in Medicaid and Medicare (dual eligibles) to transition prescription drug coverage from Medicaid to Medicare part D. Changes in payment systems and utilization management along with the loss of Medicaid protections had the potential to disrupt medication access, with uncertain consequences for dual eligibles with human immunodeficiency virus (HIV) who rely on consistent prescription coverage to suppress their HIV viral load (VL). Objective: To estimate the effect of Medicare part D on self-reported out-of-pocket prescription drug spending, AIDS Drug Assistance Program (ADAP) use, antiretroviral adherence, and HIV VL suppression among dual eligibles with HIV. Methods: Using 2003-2008 data from the Women's Interagency HIV Study, we created a propensity score-matched cohort and used a difference-in-differences approach to compare dual eligibles' outcomes pre-Medicare and post-Medicare part D to those enrolled in Medicaid alone. Results: Transition to Medicare part D was associated with a sharp increase in the proportion of dual eligibles with self-reported out-of-pocket prescription drug costs, followed by an increase in ADAP use. Despite the increase in out-of-pocket costs, both adherence and HIV VL suppression remained stable. Conclusions: Medicare part D was associated with increased out-of-pocket spending, although the increased spending did not seem to compromise antiretroviral therapy adherence or HIV VL suppression. It is possible that increased ADAP use mitigated the increase in out-of-pocket spending, suggesting successful coordination between Medicare part D and ADAP as well as the vital role of ADAP during insurance transitions.",
keywords = "ADAP, AIDS Drug Assistance Program, antiretroviral therapy, dual eligible, HIV, Medicaid, Medicare part D",
author = "Nadya Belenky and Pence, {Brian W.} and Cole, {Stephen R.} and Dusetzina, {Stacie B.} and Andrew Edmonds and Jonathan Oberlander and Plankey, {Michael W.} and Adebola Adedimeji and Wilson, {Tracey E.} and Jennifer Cohen and Cohen, {Mardge H.} and Milam, {Joel E.} and Elizabeth Golub and Adimora, {Adaora A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/MLR.0000000000000843",
language = "English (US)",
volume = "56",
pages = "47--53",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Associations between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles with HIV

AU - Belenky, Nadya

AU - Pence, Brian W.

AU - Cole, Stephen R.

AU - Dusetzina, Stacie B.

AU - Edmonds, Andrew

AU - Oberlander, Jonathan

AU - Plankey, Michael W.

AU - Adedimeji, Adebola

AU - Wilson, Tracey E.

AU - Cohen, Jennifer

AU - Cohen, Mardge H.

AU - Milam, Joel E.

AU - Golub, Elizabeth

AU - Adimora, Adaora A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The implementation of Medicare part D on January 1, 2006 required all adults who were dually enrolled in Medicaid and Medicare (dual eligibles) to transition prescription drug coverage from Medicaid to Medicare part D. Changes in payment systems and utilization management along with the loss of Medicaid protections had the potential to disrupt medication access, with uncertain consequences for dual eligibles with human immunodeficiency virus (HIV) who rely on consistent prescription coverage to suppress their HIV viral load (VL). Objective: To estimate the effect of Medicare part D on self-reported out-of-pocket prescription drug spending, AIDS Drug Assistance Program (ADAP) use, antiretroviral adherence, and HIV VL suppression among dual eligibles with HIV. Methods: Using 2003-2008 data from the Women's Interagency HIV Study, we created a propensity score-matched cohort and used a difference-in-differences approach to compare dual eligibles' outcomes pre-Medicare and post-Medicare part D to those enrolled in Medicaid alone. Results: Transition to Medicare part D was associated with a sharp increase in the proportion of dual eligibles with self-reported out-of-pocket prescription drug costs, followed by an increase in ADAP use. Despite the increase in out-of-pocket costs, both adherence and HIV VL suppression remained stable. Conclusions: Medicare part D was associated with increased out-of-pocket spending, although the increased spending did not seem to compromise antiretroviral therapy adherence or HIV VL suppression. It is possible that increased ADAP use mitigated the increase in out-of-pocket spending, suggesting successful coordination between Medicare part D and ADAP as well as the vital role of ADAP during insurance transitions.

AB - Background: The implementation of Medicare part D on January 1, 2006 required all adults who were dually enrolled in Medicaid and Medicare (dual eligibles) to transition prescription drug coverage from Medicaid to Medicare part D. Changes in payment systems and utilization management along with the loss of Medicaid protections had the potential to disrupt medication access, with uncertain consequences for dual eligibles with human immunodeficiency virus (HIV) who rely on consistent prescription coverage to suppress their HIV viral load (VL). Objective: To estimate the effect of Medicare part D on self-reported out-of-pocket prescription drug spending, AIDS Drug Assistance Program (ADAP) use, antiretroviral adherence, and HIV VL suppression among dual eligibles with HIV. Methods: Using 2003-2008 data from the Women's Interagency HIV Study, we created a propensity score-matched cohort and used a difference-in-differences approach to compare dual eligibles' outcomes pre-Medicare and post-Medicare part D to those enrolled in Medicaid alone. Results: Transition to Medicare part D was associated with a sharp increase in the proportion of dual eligibles with self-reported out-of-pocket prescription drug costs, followed by an increase in ADAP use. Despite the increase in out-of-pocket costs, both adherence and HIV VL suppression remained stable. Conclusions: Medicare part D was associated with increased out-of-pocket spending, although the increased spending did not seem to compromise antiretroviral therapy adherence or HIV VL suppression. It is possible that increased ADAP use mitigated the increase in out-of-pocket spending, suggesting successful coordination between Medicare part D and ADAP as well as the vital role of ADAP during insurance transitions.

KW - ADAP

KW - AIDS Drug Assistance Program

KW - antiretroviral therapy

KW - dual eligible

KW - HIV

KW - Medicaid

KW - Medicare part D

UR - http://www.scopus.com/inward/record.url?scp=85038396967&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038396967&partnerID=8YFLogxK

U2 - 10.1097/MLR.0000000000000843

DO - 10.1097/MLR.0000000000000843

M3 - Article

C2 - 29227443

AN - SCOPUS:85038396967

VL - 56

SP - 47

EP - 53

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 1

ER -