Abstract
Objective
To estimate the impact of the Medicare Part D coverage gap reform under the Affordable Care Act (ACA) on the utilization of and expenditures for prescription drugs within the first five years of the policy’s implementation.
Data Sources
2008‐2015 Medicare Current Beneficiary Survey (MCBS).
Study Design
We used a difference‐in‐differences approach to estimate the year‐by‐year changes in prescription drug use and expenditures before (2006‐2010) and after (2011‐2015) the ACA’s Part D coverage gap reform between Part D beneficiaries not receiving the Low‐Income Subsidy (LIS) and those receiving the LIS.
Data Collection
The study sample included Part D beneficiaries (a) aged 65 years or older; (b) not disabled or having end‐stage renal disease; (c) continuously enrolled in a Part D plan (d) having at least one prescription fill in a given year. Survey‐reported and administrative Part D events data in the MCBS were used for the analyses.
Principal Findings
After the ACA reform, annual out‐of‐pocket drug spending significantly decreased by $88 (P < .01) among non‐LIS beneficiaries compared to LIS beneficiaries, with growing decreases over time (average decreases of $41 in 2011, $49 in 2012, $105 in 2013, and $135 in 2015, P < .01 or <.05). Changes in out‐of‐pocket costs were largely driven by significant decreases among brand‐name drugs (overall decrease of $106, P < .01). Despite significantly reduced out‐of‐pocket spending, there were no significant changes in the overall number of 30‐day drug fills and total drug spending; however, changes in the use of brand‐name and generic drugs were seen after the ACA (increase of 1.9 fills for brand‐name drugs and decrease of 2.3 fills for generic drug in 2015, P < .05).
Conclusions
The ACA coverage gap reform has helped to reduce the out‐of‐pocket drug cost burden for beneficiaries, although it had no noticeable impact on drug use or total drug spending.