Medicare Part D's Effect on the Under- and Overuse of Medications: A Systematic Review
Version of Record online: 1 AUG 2011
© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 59, Issue 10, pages 1922–1933, October 2011
How to Cite
Polinski, J. M., Donohue, J. M., Kilabuk, E. and Shrank, W. H. (2011), Medicare Part D's Effect on the Under- and Overuse of Medications: A Systematic Review. Journal of the American Geriatrics Society, 59: 1922–1933. doi: 10.1111/j.1532-5415.2011.03537.x
- Issue online: 18 OCT 2011
- Version of Record online: 1 AUG 2011
- Medicare Part D;
- systematic review;
- medication overuse;
- medication underuse
OBJECTIVES: To evaluate the literature regarding the effect of Medicare Part D on the under- and overuse of specific medications and corresponding health outcomes.
DESIGN: Systematic review.
SETTING: Medline search of the peer-reviewed literature from January 1, 2006, to October 8, 2010.
PARTICIPANTS: Medicare beneficiaries who obtained drug insurance from the Part D program.
MEASUREMENTS: The review evaluated changes in the use of specific drugs or drug classes after implementation of Part D, as described in original, peer-reviewed articles.
RESULTS: Nineteen articles met inclusion criteria. Part D's implementation was associated with greater use of essential medications such as clopidogrel and statins, especially in beneficiaries who had been previously uninsured, but increases in inappropriate antibiotic use for the treatment of acute respiratory tract infections and increases in claims for the often overused proton pump inhibitor drug class were also observed. In the Part D transition period, dually eligible beneficiaries' drug use remained largely unchanged. When beneficiary cost sharing increased in the coverage gap, use of essential and overused medications declined.
CONCLUSION: Increasing drug coverage led to greater use of underused essential medications and inappropriate, or overused, medications under Medicare Part D. Despite efforts to have it do so, the Part D benefit did not sufficiently discriminate between essential and nonessential medication use.