Clinical InvestigationCongestive Heart FailureThe Medicare drug benefit (Part D) and treatment of heart failure in older adults
Section snippets
Study design, sample, and source of data
We obtained pharmacy and medical claims, and enrollment data for patients with heart failure from a large health insurer in Pennsylvania for 2003-2007. Using Part D's January 2006 implementation as a natural experiment, we compared medication utilization among 4 groups with different pharmacy benefits in 2004-2005. Two groups had quarterly pharmacy benefit limits of $150 or $350, depending solely on their county of residence (referred to hereafter as the $150 cap and $350 cap groups). A third
Results
The groups who previously had no or limited coverage were slightly older (1-2 years) and more likely to be female than the No cap group that had consistent drug coverage throughout (P < .05) (Table I). The No coverage and $150 cap groups were slightly more likely to live in areas with higher poverty levels (P < .05). There were some differences in the prevalence of comorbid mental health and medical conditions: compared with the No cap group, the No coverage group was more likely to have
Discussion
This is the first study to demonstrate that Medicare Part D was associated with increased use of heart failure medications. These findings are consistent with a major goal of the policy, which was to reduce financial barriers to medication access among the elderly. Previous studies have shown that, before Part D, rates of prescribing of and adherence to pharmacotherapy regimens for heart failure were suboptimal.19, 20 For example, only 43.6% of incident heart failure patients in the
References (28)
- et al.
ACCF/AHA guidelines for the diagnosis and management of heart failure in adults
J A Coll Cardio
(2009) - et al.
Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE
Lancet
(1997) - et al.
Presentation adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives
J Clin Epidemiol
(1993) - et al.
The assessment of refill compliance using pharmacy records: methods, validity, and application
J Clin Epidemiol
(1997) - et al.
Time trends in the use of beta-blockers and other pharmacotherapies in older adults with congestive heart failure
Am Heart J
(2004) - et al.
Validation of diagnostic codes within medical services claims
J Clin Epidemiol
(2004) - et al.
Incidence and prevalence of heart failure in elderly persons, 1994-2003
Arch Intern Med
(2008) Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study
N Engl J Med
(1987)- et al.
Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS)
Eur Heart J
(2005) - et al.
Quality indicators for the care of heart failure in vulnerable elders
J Am Geriatr Soc
(2007)