Background: In 2006, Medicare implemented its prescription benefit plan. Therefore, insights into medication costs at the end of life may help guide clinicians to navigate Medicare Part D coverage for chronically ill individuals. Objectives: We examined drug spending by disease and demographics for Medicare+Choice (M+C) beneficiaries in the last year of life (LYOL). Research design: Retrospective review of M+C decedents' drug claims and enrollment data collected between January 1998 and December 2000, supplemented by the Medicare denominator file and 1990 Census data. Subjects: Four thousand six hundred two beneficiaries in a large national managed care organization. Measures: We analyzed the relationship between prescription drug expenditures and sociodemographic descriptors, insurance characteristics, and cause of death. Results: The mean annual number of prescriptions filled was 36.9; the managed care organization (MCO) paid $539 and beneficiaries paid $627. Higher expenditures were significantly correlated with female gender, higher number of comorbidities, and whether beneficiaries obtained the insurance as an employer-based retiree benefit. Minority beneficiaries had 26% fewer prescriptions. Increasing levels of annual median household income corresponded with a 20% increase in the number of prescriptions and a 25% increase in mean out-of-pocket expenses, between those with a median household income of less than $20,000 and those with $40,000 or greater. In the LYOL, chronic obstructive pulmonary disease and diabetes had the highest average number of prescriptions and total expenditures. Individuals dying from strokes or other un-classifiable conditions had the lowest average number of prescriptions and average total ex-penditures. Conclusion: Medication expenditures in the LYOL were highly dependent upon selected sociodemographic, insurance characteristics, and disease states.
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine