The Role of Benefit Design in Enrollment, Use and Spending in State Prescription Drug Assistance Programs for Seniors - Lessons for Medicare

How does the design of a prescription drug benefit for seniors – either under Medicare or in individual states – affect drug use and costs? Building on evaluations currently underway for CMS, the researchers compared the SeniorCare prescription drug assistance programs in Illinois and Wisconsin to assess the impact of different key features, including enrollment approach and fees, and the use of a PBM or not. The scope of the CMS evaluations of the Medicaid 1115 waivers in each state does not permit direct comparison of the programs to assess the impact of the different design features. The researchers: 1) compared enrollment selection between the two programs; 2) compared utilization and spending patterns for enrollees; 3) assessed the impact of Illinois’ ‘soft cap’ and Wisconsin’s deductible on drug use and spending; and 4) compared patterns of use for specific diseases (COPD/asthma, congestive heart failure, diabetes, and arthritis) and drug therapeutic classes in each of the states.