Background: Medicare Part D beneficiaries who reach the drug benefit threshold (DBT) risk adverse health outcomes.
Objectives: We explore clinical characteristics of beneficiaries who repeatedly reach the DBT during the first 2 years of Medicare Part D and may benefit from proactive identification for medication and care management.
Research Design: Retrospective cohort.
Subjects: 25,320 Medicare Advantage beneficiaries of whom 536 reached the DBT in 2006 only, (“2006 only”); 961 reached the DBT in 2006 and 2007 (“both years”); and 23,823 in neither year.
Measures: We assessed repeatedly reaching the DBT (relative to 2006 only) as a function of demographics, morbidity (specific conditions and overall burden), medication use (specific classes and overall burden), utilization, and use of catastrophic and/or additional pharmacy benefits.
Results: Those who reached the DBT in both years had higher morbidity and utilization. In multivariate analyses, they were more likely than the 2006 only group to have one or more of 5 conditions (chronic pulmonary disease, dementia, depression, incontinence, and Parkinson disease), and within these conditions were more likely to use categories of trade-name medications for which there are limited available generic alternatives.
Conclusions: Repeatedly reaching the DBT is a function of the extent and chronicity of disease burden and is characterized by conditions for which there is limited availability of generic medications, and associated common comorbidities. If these findings are confirmed, strategies at practice and policy levels may help such Medicare beneficiaries avoid unnecessary out of pocket expenditures on medications from prematurely reaching the DBT.