Objectives: The Centers for Medicare and Medicaid Services tested the Part D Senior Savings Model (the 'PDSS Model') from 2021 to 2023, capping insulin cost-sharing at $35/month for Medicare beneficiaries in participating plans. The objective of the study was to assess the PDSS Model's effects on various categories of healthcare costs.
Methods: This study analysed the US Medical Expenditure Panel Survey (2020-2021). Study outcomes included costs for insulin, all medications, health services, and overall healthcare. Costs were calculated from patient (out-of-pocket) and healthcare sector perspectives. A difference-in-differences approach was implemented using generalized linear regression to compare cost changes from 2020 to 2021 between Medicare beneficiaries aged 65 and older and near-elderly non-Medicare individuals with private insurance.
Key findings: Compared to non-Medicare patients, Medicare beneficiaries in general experienced higher reductions in out-of-pocket costs over time: 29% for insulin (cost ratio [CR] = 0.71, 95% confidence interval [CI] = 0.56-0.90), 66% for health services (CR = 0.34, 95% CI = 0.26-0.44), and 49% for overall healthcare (CR = 0.51, 95% CI = 0.34-0.77). For total costs, Medicare beneficiaries had a 41% smaller increase in insulin costs (CR = 0.59, 95% CI = 0.39-0.90) and a 42% smaller increase in medication costs (CR = 0.58, 95% CI = 0.46-0.74). Medicare beneficiaries experienced a 73% greater increase in total health service costs (CR = 1.73, 95% CI = 1.09-2.77).
Conclusions: The PDSS Model was generally associated with reduced out-of-pocket insulin and other out-of-pocket healthcare costs among Medicare beneficiaries, highlighting the value of cost-saving models.
Objectives: This study examined the effects of the comprehensive medication review of Medicare medication therapy management programs on opioid overuse among Medicare beneficiaries.
Methods: This retrospective study analyzed Medicare data from 2016 to 2017. The intervention group included Medicare beneficiaries who newly received comprehensive medication review in 2017; the control group referred to patients who met the general eligible criteria for the medication therapy management program but did not enroll in 2016 or 2017. Propensity score matching was performed to increase characteristic compatibility between the intervention and control groups. Three measures of opioid overuse were analyzed: use of opioids at a high dosage, use of opioids from multiple providers, and concurrent use of opioids and benzodiazepines. The effects of comprehensive medication review on opioid overuse were analyzed with a multivariate logistic regression with an interaction term between the receipt of comprehensive medication review and the year 2017.
Key findings: The proportion of concurrent use of opioids and benzodiazepines declined at a greater rate among the recipients (2.21%) than non-recipients (1.55%) of the comprehensive medication review. In the adjusted analysis, the odds ratio of no concurrent use of opioids and benzodiazepines was 5% higher (1.05; 95% confidence interval = 1.02-1.09) among recipients than non-recipients. These significant findings were not found for the other two measures of opioid overuse.
Conclusions: Comprehensive medication review is associated with reduced concurrent use of opioids and benzodiazepines among Medicare beneficiaries. Such service should be incorporated into the current approaches for addressing the opioid epidemic.
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