The NIH National Institute on Aging (NIA) has awarded $218,250 for Year 1 of the investigation of “Utilization Management in the Medicare Part D Program” proposed by Dr. Martin Andersen, Assistant Professor of Economics.
Abstract: Utilization management policies, which include prior authorization requirements, step therapy protocols, and quantity limits, are becoming increasingly common in Medicare Part D plans. However, the health consequences of these policies for Medicare Part D beneficiaries who do not also (or did not in the past) have Medicaid coverage and who are not nursing home residents has not been well-studied. The objectives of this project are to study the effect of utilization management policies on health and to disentangle the effect that denials of treatment due to utilization management have on health. We propose to study both overall prescription drug utilization and health outcomes as well as three specific clinical indications—diabetes, for whom effective drug therapy should prevent emergency room and hospital admissions due to elevated blood glucose; individuals with urinary tract infections; and pneumonia, which should, in most cases, be effectively treated in the outpatient setting with prescription drugs. To complete these objectives, we will analyze administrative claims data from the Medicare Parts A, B, and D programs covering inpatient care, outpatient care, and prescription drugs, respectively. This project will inform policymakers about the implications of utilization management in the Medicare Part D program.