tui dissertation defense abbrv hales (linkedin)
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DESCRIPTIONAn Abbreviated version of the defense presentation presented to the PhD committee of TUI University
- 1. Standard Medicare Drug Benefit, 2006 $386 average annual premium*** $250 Deductible $2,250 in Total Drug Costs* $5,100 in Total Drug Costs** 25% 5% $2,850 Gap: Beneficiary Pays 100% Medicare Pays 75% Medicare Pays 95% No Coverage(the doughnut hole) Catastrophic Coverage Partial Coverage up to Limit BeneficiaryOut-of-Pocket Spending *Equivalent to $750 in out-of-pocket spending. **Equivalent to $3,600 in out-of-pocket spending. ***Based on $32.20 national average monthly beneficiary premium (CMS, 8/05). SOURCE: KFF analysis of standard drug benefit described in Medicare Modernization Act of 2003.www.kaisered.org
2. The Doughnut Hole National Committee to Preserve Social Security and Medicare. http://www.ncpssm.org/news/archive/update_partd_2008/ 3. Problem Statement
- Thedoughnut holemay influence prescription fulfillments since low co-payments will be replaced with high out-of-pocket costs.
- Medicare Part D members prescription fulfillment decisions, defined as filling, delaying, switching, or completely stopping the fulfillment of a prescription, might be affected by a sudden benefit design change (100 percent cash prescription responsibility) as defined as thedoughnut hole.
- Studies need to be conducted to determine whether thedoughnut holeaffects prescription decisions of Medicare Part D enrollees .
4. Study Aim and Purpose
- The purpose of the study is to determine whether thedoughnut holehas any effect on prescription medication utilizationas measured by filling, delaying, switching or cessation of the purchase of a prescription medication .
- The specific aims of the study are as follows:
- 1. The first aim of the study is to determine the effect of thedoughnut holeon the filling of prescription medication.
- 2. The second aim of the study is to determine the effect of thedoughnut holeon delaying the purchase of prescription medication.
- 3. The third aim of the study is to determine the effect of thedoughnut holeon switching of prescription medication.
- 4. The fourth aim is to determine the effect of thedoughnut holeon prescription medication cessation.
- 5. The fifth aim is to determine the effect of utilization against the confounding effects of the following covariates:age, gender, number and type of medication.
5. Research Design
- A case control, pharmacy adjudication, prescription fulfillment study design coding prescription fulfillment decisions into the dependent variable nominal categories of filled, switched, delayed, and stopped.
- Each prescription of each Part D participant within the HMO will be followed monthly throughout 2006 via a Part D health plans pharmacy adjudication database.
- Statistical analysis of the prescription decisions by members over one full year of enrollment. Enrollees (n=500) will be analyzed for the effect of the independent variable, thedoughnut hole , for 1 entire year.
- In addition, a group of enhanced members (n = 250) withdoughnut holecoverage will provide a control group for the primary study group (members with standard Medicare PDP benefits - or non-coverage through thedoughnut hole ).
- In compliance with HIPAA regulations, patient information will be blinded. Thus, no patient names will be disclosed in this research ensuring full-protection of human subjects health information privacy.
6. Days Spent in the doughnut hole Legend:Distribution of Days Spent by Members in the Doughnut Hole The graph displays the distribution of days spent in the doughnut hole by the 500 members of the standard Part D prescription drug plan (standard PDP).The mean was 144.68 days +/- 2.268 SEM. 7. Rx Fulfillment Behaviors Legend:Fulfillment Behaviors for Members Who Experienced the Doughnut Hole This table shows the prescription fulfillment behaviors of standard PDP members.Data are expressed in terms of the frequency, percent, and cumulative percent. Total number of participants n = 500. Legend:Fulfillment Behaviors for Memberswithouta Doughnut Hole This table shows the prescription fulfillment behaviors of enhanced members.Data are expressed in terms of the frequency, percent, and cumulative percent. Total number of participants n = 250. Fulfillment Behaviors for Members Who Experienced the Doughnut Hole Fulfillment Behaviors for Members without a Doughnut Hole100.0 500 Total 5.6 28 Switched, Stopped, and Delayed 10.0 50 Delayed and Stopped 5.2 26 Switched and Stopped 9.8 49 Switched and Delayed 6.0 30 Stopped 22.0 110 Delayed 13.4 67 Switched 28.0 140 Filled Percent Frequency Doughnut Hole = Y 100.0 250 Total 1.2 3 Switched, Stopped, and Delayed 8.4 21 Delayed and Stopped 4.0 10 Switched and Stopped 3.2 8 Switched and Delayed 8.4 21 Stopped 10.8 27 Delayed 10.0 25 Switched 54.0 135 Filled Percent Frequency Doughnut Hole = N 8. Rx Fulfillment Behaviors Frequency graphs Legend:Rx Fulfillment Behavior of Standard PDP Members This figure shows the prescription fulfillment behavior of standard PDP members when experiencing the doughnut hole.Data are expressed as the mean of the number of participants who 1 = filled, 2 = switched, 3 =delayed, 4 = stopped, 5 = both switched and delayed, 6 = switched and stopped, 7 = delayed and stopped, or 8 = switched, stopped and delayed their prescription medication. Total number of participants n = 500. Legend:Rx Fulfillment Behavior when NOT Experiencing the Doughnut Hole This figure shows the prescription fulfillment behavior of enhanced members, who do NOT experience the doughnut hole.Data are expressed as the mean of the number of participants who 1 = filled, 2 = switched, 3 =delayed, 4 = stopped, 5 = both switched and delayed, 6 = switched and stopped, 7 = delayed and stopped, or 8 = switched, stopped and delayed their prescription medication. Total number of participantsn = 250. Frequency Frequency 9. Percentage of Classes Affected Legend:Percentage of Classes Affected by Prescription Fulfillment Decisions of Standard PDP Members This pie chart shows the percentages for the classes which were impacted by prescription fulfillment behaviors of standard PDP members.Data are percent.Total number of participants n = 500. 10. Odd Ratios Legend:Descriptive Cross Tabulation for Prescription Fulfillment Behaviors and the presence of adoughnut holewith Odds Ratios The above table compares the prescription fulfillment behaviors identified for members experiencing and Not experiencing thedoughnut hole .Prescription fulfillment frequencies are displayed for each type of prescription fulfillment behavior possible from a member; these are separated by group (those who experienced the doughnut hole compared with those who did NOT experience the hole.Odd ratios are displayed for each classification of finalized cumulative prescription decisions made by members (p