1. Implementation of Medicare Part D and Nondrug Medical Spending for Elderly Adults With Limited Prior Drug Coverage Haiden Huskamp PhD, J. Michael McWilliams MD, Alan Zaslavsky Jon Wilson Mercer PharmD Candidate C/O 2012

2. Medicare Part D Introduced in January 2006 Increased medication use Reduced out of pocket costs Adherence to essential medications for elderly persons

3. Before Part D Limits on drug benefits for elderly adults were associated with greater use of acute care

4. Objective To assess changes in nondrug medical spending following the introduction of Part D for Medicare beneficiaries with limited prior drug coverage. Study cohort(2004-2007) and control cohort(2002-2005)** **To assess changes in spending when not affected by Part D

5. Study Cohort Longitudinal survey data and Medicare claims from 2004-2007. – Data before and after implementation of Part D – 2538 patients with generous drug coverage before 2006 – 3463 patients with limited drug coverage before 2006

6. Control Cohort Survey Participants from 2002-2005 – 2537 with generous drug coverage – 3451 with limited drug coverage

7. Study Population Inclusion – Enrolled in traditional Medicare at the beginning of 2002/2004 Exclusion – Patients who became eligible for Medicare before age 65 – Military Veterans who received care from VA Criteria the same for both Study and Control Cohorts

8. Nondrug Medical Spending Assessed quarterly Inpatient and skilled nursing facility institutional services cover by Part A Physician and ancillary services covered by Part B Since Part B covers inpatient and outpatient physician services, outpatient data was analyzed to distinguish differences

9. Results Nondrug medical spending after Part D was 3.9% lower for participants with limited prior drug coverage than those with generous coverage. -$306/quarterly between observed and expected

10. Results

12. Control Cohort Results Differences in nondrug medical spending between participants with limited vs. generous drug coverage in 2002 were similar before and after January 1, 2004.

13. Control Cohort Results

14. Conclusion Implementation of Part D was associated with differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.

15. Comment Increased medication use and adherence achieved through Part D have been associated with decreased spending for nondrug medical care. Drug coverage gains may have also reduced early complications of acute conditions.

16. Level of Evidence