Researchers from Brigham and Women’s Hospital (BWH), Harvard Medical School (HMS) and Adheris announced today the results of a new study that examined medication use, out-of-pocket spending, and medication switching during the transition of Medicaid-eligible seniors to Medicare Part D. Their findings appear in the December 2008 issue of the Journal of the American Geriatrics Society.

On January 1, 2006, The Centers for Medicare and Medicaid Services enacted a transition plan that automatically enrolled seniors dually eligible for Medicare and Medicaid (dual eligibles) into subsidized Part D programs; while participating Medicare Part D plans were required to relax drug restrictions at the point of conversion. The transition from Medicaid, with its generous drug coverage, to Medicare Part D, with its tiered pharmacy plans and formulary restrictions, caused widespread concern about compromised access to essential medications despite the precautionary measures listed above. This led many policy experts to question how the transition would affect prescription drug use.

BWH, HMS, and Adheris researchers evaluated drug use for 13,032 dual eligibles transitioning to Medicare Part D taking either clopidogrel, warfarin, statins, proton pump inhibitors (PPIs), or benzodiazepines (which are not covered through Part D). Their findings show that the transition to Medicare Part D had no significant effect on the use of all study drugs, including the uncovered benzodiazepines. Cumulative reductions were seen in out-of-pocket expenses for all covered drugs, but there was a significant increase (over 90%) in out-of-pocket costs for the uncovered benzodiazepines. There was no significant change in the rate of medication switching in all study drugs except for the PPIs. However, there is convincing evidence that medications in the PPI class have similar efficacy.

“Fear about medication discontinuation and adverse health outcomes is often invoked as a reason to obstruct new policy implementation,” said Dr. William Shrank, an instructor at Harvard Medical School and the study’s lead author. “These study findings suggest that thoughtful preparation for transition to new coverage designs and use of strategies to ease the burden of transition may serve as an effective means of protecting patients without impeding progress.”