1. Muskie School of Public Service Institute for Health Policy Evaluating the Impact of Part D on Beneficiaries: Early Lessons Susan Payne Institute for Health Policy Muskie School of Public Service 2006 Academy Health Annual Research Meeting Seattle, Washington

2. Muskie School of Public Service Institute for Health Policy Objectives To describe the early impact of an outreach and education effort to encourage Part D enrollment To draw lessons for evaluating the impact of Part D on beneficiaries

3. Muskie School of Public Service Institute for Health Policy Experience of MaineCare Workers with Disabilities -- Dual Eligibles -- before and during the Transition from Medicaid to Medicare Part D Authors: Carolyn Gray and Larry Glantz Consultants: Kim Fox and Susan Payne Funded by CMS

4. Muskie School of Public Service Institute for Health Policy The Workers with Disabilities option (aka WWD Option, Working Disabled, or Medicaid Buy In) Enables workers with disabilities to earn up to 250% Federal Poverty Level and still keep MaineCare (Maine Medicaid) benefits Eligibility Meet Social Security guidelines for a disability Have a job Meet financial guidelines More info at www.maine.gov/dhhs/beas/workwww.maine.gov/dhhs/beas/work

5. Buy In participants are dual eligibles – Medicare and MaineCare. Nationally, 36% of Medicare beneficiaries are dual eligibles. They tend to have fewer financial resources, more health problems, and higher health care costs than other Medicare beneficiaries.

6. Muskie School of Public Service Institute for Health Policy Special outreach was in addition to assistance from MaineCare to all dual eligibles Informational phone calls: Provided basic information about the transition to raise awareness and provide resource information Brochures and mailings: Information on what the change means for duals, how to decide what plan is best, potential problems getting medications, and how to resolve issues Informational sessions and video: Targeted sessions for service providers and for duals about transition to Part D Webpage: Disability-specific information and resources linked to the state’s Medicare Part D website

7. Muskie School of Public Service Institute for Health Policy Survey to assess special outreach efforts to Buy-In Members Supported by CMS Phone interviews conducted in March, 2006, 66 questions. Knowledge about Part D, evaluation of outreach and education efforts, experience so far in using it $5 prepaid phone card offered as an incentive Average time of 15 minutes 60% response rate: 299/501

8. Muskie School of Public Service Institute for Health Policy Caveats Self reported information -- not validated Emergency coverage (“wrap”) was in effect -- measures impact on enrollment

9. Muskie School of Public Service Institute for Health Policy Results There was a high level of reported enrollment – 87%. There was still some lack of knowledge…..

10. Muskie School of Public Service Institute for Health Policy Letters and news/newspapers most common source of information In person assistance the most helpful.....

11. Muskie School of Public Service Institute for Health Policy 85% had tried to buy medications under Part D. Of those..... 19% had problems getting a prescription filled 15% had to switch to a different medication 4% had to switch to a different pharmacy 8% said the change in coverage affected their health There was some confusion and lack of information about enrollment.

12. Muskie School of Public Service Institute for Health Policy Conclusions There will be a continuing need for personalized outreach and education to beneficiaries. It is feasible to get information from beneficiaries on Part D by phone.

13. Muskie School of Public Service Institute for Health Policy Evaluation of the MaineCare Preferred Drug List : Preliminary results Authors: Susan Payne, Robert Keith, Deborah Thayer, and Erika Ziller Funded by: Maine Department of Health and Human Services and Edmund S. Muskie School of Public Service

14. Muskie School of Public Service Institute for Health Policy Objective To evaluate the impact of the MaineCare (Maine Medicaid) Preferred Drug List (PDL) on Continuity of medication use Potentially drug-related adverse event rates

15. Muskie School of Public Service Institute for Health Policy Data and methods Design: Retrospective observational study Population: MaineCare members eligible for full benefits for >5 months during the study period who were enrolled prior to April 1, 2003 Data: MaineCare and Medicare administrative data. Due to data limits, this report covers MaineCare only group (n= c. 200,000) Study period: January, 2003, through June, 2004 (18 months pre PDL, 18 months post PDL) Medications: 67 higher-volume medications, with medications consistently classified and used as either preferred or non-preferred during the study period Analysis: Descriptive statistics, graphs, and Poisson regression analysis

16. Muskie School of Public Service Institute for Health Policy Preliminary results: Continuity Members discontinued medications frequently before the PDL was introduced. There were different patterns by medication: Changes in medication discontinuity from pre-PDL to full PDL implementation period (n=67) Number and percent of Therapeutic subclasses with… Preferred medications Non-preferred medications Increase in discontinuity38.9%91.0% No change9.0%3.0% Decrease in discontinuity52.2%6.0% Total100.0%

17. Muskie School of Public Service Institute for Health Policy Adverse events -- deaths, drug-related falls, adverse drug reactions, emergency visits, hospital and nursing home admissions There were no apparent trends in adverse event rates when all members were studied. Trends did show up when smaller groups were studied.

18. Muskie School of Public Service Institute for Health Policy Looking at the subgroup of members who discontinued a drug after it was put on the PDL….. Rates for some adverse events got Better (dropped) after the PDL was implemented: emergency visits Stayed the same: deaths, falls, adverse drug reactions, nursing facility admissions Got worse (increased): hospital admissions

19. Muskie School of Public Service Institute for Health Policy Conclusions Include a broad range of therapeutic classes of medications. Compare use and switching patterns before and after Part D. Document changes in formularies over time OR study only medications that were consistently classified.

20. Muskie School of Public Service Institute for Health Policy Study subgroups. Include a variety of outcomes. Account for related measures. Medicaid was a great source of information on members’ medication use prior to Part D. This emphasizes the importance of current, comprehensive data on medication use after Part D.