title: Comparison of the claim percent gross margin earned by Texas community independent pharmacies for dual-eligible beneficiary claims before and after Medicare Part D.
abstract: OBJECTIVE
  To describe dual eligibles' claims before and after Medicare Part D and to evaluate the effect that Medicare Part D has had on the claim percent gross margin (CPGM) earned by Texas community independent pharmacies.
  
  
  METHODS
  Nonexperimental time series study.
  
  
  METHODS
  Texas, October 2005 through September 2006.
  
  
  METHODS
  313 community independent pharmacies.
  
  
  METHODS
  Review of more than 150,000 Medicaid and 300,000 Medicare Part D claims acquired from a drug claims processor.
  
  
  METHODS
  CPGM per prescription claim before and after the implementation of Medicare Part D, controlling for generic/brand drug status.
  
  
  RESULTS
  The mean CPGM for prescriptions dispensed before Part D (Medicaid claims) was 26.7%. The mean CPGM for claims dispensed after Part D (Medicare claims) was 17.0% (using ingredient costs in 2006 dollars) or 20.4% (using ingredient costs adjusted to 2005 dollars), a reduction of 36.3% and 23.6%, respectively. Under both Medicaid and Part D, pharmacies earned higher margins for generic drugs (39.9% and 29.5%, respectively) than for brand-name drugs (8.7% and 8.3%, respectively).
  
  
  CONCLUSIONS
  These results support community pharmacy assertions of lower reimbursements from Part D payers compared with Medicaid payers. Based on these results, pharmacies can respond to this evolving environment by carefully reviewing their Part D plans' impact on CPGM and taking available steps to increase the proportion of generic drugs dispensed to Medicare beneficiaries.
authors.affiliation: College of Pharmacy, University of Texas at Austin, University Station, A1900, Austin, TX 78712, USA.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Winegar
authors.forename: Marvin D
authors.initials: MD
authors.lastname: Shepherd
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Lawson
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Richards
mesh_terms: D016527:Drug Costs; D006801:Humans; D019458:Insurance Coverage; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D054524:Medicare Part D / Q000191:economics*; D010594:Pharmacies / Q000191:economics*; D013781:Texas; D013997:Time Factors; D014481:United States