RESUMO
OBJECTIVES: To examine variation in risk-adjusted reinsurance payments across Part D plans, analyze its implications for the program, and explore options to reduce reinsurance payments. DATA/STUDY DESIGN: 2007-2015 Part D Plan Payment and Premium data; 2010-2013 Part D Prescription Drug Event data; and 2013 Part D Plan Formulary Files. PRINCIPAL FINDINGS: Risk-adjusted reinsurance payments varied widely across plans at a given out-of-pocket (OOP) premium. The variance in risk-adjusted reinsurance in common OOP premium ranges increased between 2010 and 2015. High risk-adjusted reinsurance payments were negatively correlated with use of utilization management tools for high-cost drugs. CONCLUSIONS: Growing reinsurance payments shrink plans' liability for managing drug spending for high-cost enrollees, creating plan moral hazard, and making OOP premiums a noisy signal of plans' total costs.
Assuntos
Proposta de Concorrência , Custos de Medicamentos/tendências , Gastos em Saúde/tendências , Medicare Part D/economia , Humanos , Estados UnidosRESUMO
OBJECTIVE: To examine the impact of the 340B drug discount program on the site of cancer drug administration and cancer care spending in Medicare. DATA SOURCES/STUDY SETTING: 2010-2013 Medicare claims data for a random sample of Medicare Fee-for-Service beneficiaries with cancer. STUDY DESIGN: We identified the 340B effect using variation in the availability of 340B hospitals across markets. We considered beneficiaries from markets that newly gained a 340B hospital during the study period (new 340B markets) as the treatment group. Beneficiaries in markets with no 340B hospital were the control group. We used a difference-in-differences approach with market fixed effects. DATA COLLECTION: Secondary data analysis. PRINCIPAL FINDINGS: The probability of a patient receiving cancer drug administration in hospital outpatient departments (HOPDs) versus physician offices increased 7.8 percentage points more in new 340B markets than in markets with no 340B hospital. Per-patient spending on other cancer care increased $1,162 more in new 340B markets than in markets with no 340B hospital. CONCLUSIONS: The 340B program shifted the site of cancer drug administration to HOPDs and increased spending on other cancer care. As the program expands, continuing assessment of its impact on service utilization and spending would be needed.