Potential opportunity cost of neglecting to annually reassess Medicare Part D standalone prescription drug plan offerings: the price of contentment?

OBJECTIVES

To determine the (1) potential cost difference (opportunity cost [OC]) to Medicare-eligible beneficiaries enrolled in the lowest-cost standalone prescription drug plan (PDP) in 2007 between the cost of such plan in 2008 and the lowest-cost plan in 2008 and the (2) percentage of PDPs with the lowest estimated annual cost (EAC) in both 2007 and 2008.

DESIGN

Descriptive exploratory study.

SETTING

United States during 2007 and 2008.

PATIENTS

50 patients were randomly selected from a database of Medicare-eligible beneficiaries.

INTERVENTION

Pharmacy claims records for each study patient were obtained during the period January 1 to June 30, 2007. Patient medication profiles were generated using these data and entered into the Medicare Plan Finder Tool (www.medicare.gov) to obtain the EAC of each PDP from 2007 and 2008 in all 34 Medicare Part D regions.

MAIN OUTCOME MEASURES

The 2008 EAC of the lowest-cost PDP from 2007 was recorded. OC was determined by subtracting the 2008 EAC of the lowest-cost PDP in 2008 from the 2008 EAC of the lowest-cost PDP in 2007 for each patient in each region. The percentage of PDPs that had the lowest EAC in both 2007 and 2008 was recorded.

RESULTS

The 2008 EACs of the lowest-cost PDPs from 2007 were significantly higher (P < 0.001) than the lowest-cost PDPs of 2008 within all 34 Medicare regions. The mean OC ranged from $276 to $562 nationally. Only 12% of plans were the lowest-cost PDP in both 2007 and 2008.

CONCLUSION

Medicare beneficiaries should reevaluate PDP offerings annually during the open enrollment period; failure to do so may increase avoidable out-of-pocket costs.