Regular Research ArticlesImpact of Medicare Part D on Antidepressant Treatment, Medication Choice, and Adherence Among Older Adults With Depression
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Study Design and Source of Data
This study was approved by the University of Pittsburgh institutional review board. The source of data was a large health insurance company in Pennsylvania that offered a variety of insurance plans to Medicare beneficiaries. We obtained prescription drug, medical claims, and enrollment data from the company's Medicare Advantage managed care plans for 2004–2007. Older adults enrolled with this insurance company had one of four types of drug coverage before Part D. Two groups, who enrolled in
Characteristics of the Study Sample
The characteristics of the study sample are presented in Table 1. The groups with limited or no drug coverage prior to Part D were slightly older (mean age 76.84, 76.06, and 75.47 in the No coverage, $150 and $350 cap groups, respectively, compared to 74.21 in the employer group, analysis of variance, df = 1, p <0.05). The groups with $150 and $350 quarterly caps were more likely than the employer group to be woman (78.48% and 75.68%, respectively, versus 68.21%, χ2, df = 1, p <0.05). The three
DISCUSSION
Our study is the first to examine the impact of the new Medicare drug benefit on likelihood of antidepressant treatment, medication choice and refill adherence for older adults with depression who previously lacked or had minimal drug coverage.
Part D was associated with an increased likelihood of antidepressant treatment among older adults diagnosed with depression, who previously lacked drug coverage. This result is consistent with a major goal of Part D, to reduce financial barriers to
References (32)
Clinical and health services relationships between major depression, depressive symptoms, and general medical illness
Biol Psychiatry
(2003)- et al.
Depression, cardiovascular disease, diabetes, and two-year mortality among older, primary care patients
Am J Geriatr Psychiatry
(2005) - et al.
Cost-related medication nonadherence among beneficiaries with depression following Medicare Part D
Am J Geriatr Psychiatry
(2009) - et al.
The assessment of refill compliance using pharmacy records: methods, validity, and application
J Clin Epidemiol
(1997) - et al.
Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life
Arch Gen Psychiatry
(2003) - et al.
Reducing suicidal ideation and depressive symptoms in depressed older primary care patients
JAMA
(2004) - et al.
Predictors of suicide in the old elderly
Gerontology
(2003) - et al.
Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: a 4 year prospective study
JAMA
(1997) - et al.
Depressive symptoms and health costs in older medical patients
Am J Psychiatry
(1999) - et al.
Suboptimal antidepressant use in the elderly
J Clin Psychopharmacol
(2005)
Depression and cost-related medication nonadherence in Medicare beneficiaries
Arch Gen Psychiatry
Medicare Chartbook 2005
Fact Sheet: The Medicare Prescription Drug Benefit, Kaiser Family Foundation
The effect of medicare part D on drug and medical spending
N Engl J Med
The impact of medicare part D on prescription drug use by the elderly
Health Aff
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Presented in part at the Academy Health Annual Research Meeting, Washington, District of Columbia, June 10, 2008; and the American Society of Health Economists meeting in Durham, North Carolina, June 25, 2008.
Drs Lave and Zhang are investigators for a project in part funded by Highmark Inc (a Medicare-Advantage plan) to evaluate the economic impact of high-deductible health plan on medical care spending. Dr. Reynolds receives pharmaceutical supplies for his NIH-sponsored research from Pfizer, Forest, BMS, Wyeth, and Lilly.
This publication was supported by the National Center for Research Resources, National Institutes of Health (NIH) (KL2 RR-024154-04), Agency for Healthcare Research and Quality (R01HS017695), NIH grants (R34 MH082682, R01AG027017, P30AG024827, P30MH71944, T32AG021885, K07AG033174, R01AG034056), the Veterans Administration Health Services Research and Development Service (IIR-06-062), the UPMC endowment in geriatric psychiatry, and John A. Hartford Foundation.