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Research Abstracts Online
January - December 2011

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University of Minnesota Twin Cities
School of Public Health
Division of Health Policy and Management

PI: Pinar Karaca-Mandic

Understanding Geographic Variation in Medicare Part D: Effects of Plan Design on Utilization and Expenditures

This study examines the geographic variations in prescription drug utilization and spending patterns for the Medicare population using the newly released Part D claims data along with several other administrative and public use data sources. Study objectives include: documenting the variation across time and geographic regions in utilization, total expenditures, and out-of-pocket (OOP) expenditures of prescription drugs among Medicare beneficiaries with Part D coverage; documenting the variation across geographic regions and time in the Part D plan benefit designs (e.g., premiums, deductibles, cost-sharing, initial coverage limit before the coverage gap (donut hole), coverage of generics or brands in the donut hole); documenting the variation across geographic regions and time in the comprehensiveness and utilization management of Part D formularies (e.g. coverage of major drugs by therapeutic class, use of quantity limits, prior authorization, step therapy) as well as the within-year stability of the formularies (i.e. extent of negative and positive changes in formulary coverage within the contract period); and estimating the role of plan benefit design generosity, plan formulary characteristics (comprehensiveness, utilization management), pharmacy characteristics, prescriber characteristics as well as other relevant regional conditions, in explaining variation in utilization and OOP expenditures. The researchers analyze these objectives separately for the two types of Part D plans, Medicare Advantage Prescription Drug coverage (MA-PD) and standalone prescription drug plans (PDPs). Additionally, they are stratifying their analysis by therapeutic drug class, focusing on four different classes: gastrointestinal agents, anti-hyperlipidemics, and oral anti-diabetics, and oral osteoporosis drugs.

Group Members

Jean Abraham, Faculty Collaborator
Chia-Wei Lin, Graduate Student
Jeffrey S. McCullough, Faculty Collaborator
Tami C. Swenson, Graduate Student