Minimizing out-of-pocket prescription drug costs for Medicare beneficiaries: not just a drop in the bucket

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Journal of the American Pharmacists Association









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Objective: To identify the frequency of uptake and financial impact of four cost-minimization strategies used to assist Medicare beneficiaries in lowering their out-of-pocket (OOP) costs.

Design: Cost-savings analysis.

Setting: Twelve outreach events were conducted in six different cities throughout Northern and Central California during the 2013 Medicare open enrollment period.

Participants: Noninstitutionalized Medicare beneficiaries from various socioeconomic backgrounds, including those receiving Medicaid.

Main outcome measures: Potential OOP cost savings for the upcoming year.

Results: In total, 621 beneficiaries were assisted. Part D plan optimization was performed for 535 beneficiaries; the findings indicated that 435 (81%) could save money (average: $1,334) by switching plans in the upcoming year. The results also demonstrated that 28 beneficiaries could save money (mean: $1,274) through a patient assistance program. In total, 16 beneficiaries had self-reported income and/or assets that were low enough to qualify for additional governmental assistance through the low-income subsidy. Finally, less costly therapeutic alternatives were identified for 7 beneficiaries and prescribers accepted recommendations for change in 6 (85%) such cases. In total, beneficiaries could realize more than $770,000 in potential OOP savings from the performed interventions.

Conclusion: Targeted assistance to beneficiaries through a variety of cost-lowering strategies can help significantly reduce OOP costs and thus may also result in lower cost-related medication nonadherence and improved beneficiary outcomes.


Disclosure: The authors declare no conflicts of interest with or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

Funding: The research was partially funded by a United Way Community Impact Grant.

Previous presentation: American Public Health Association 141st Annual Meeting, Boston, MA, November 4, 2013.