Comparison of the claim percent gross margin earned by Texas community independent pharmacies for dual-eligible beneficiary claims before and after Medicare Part D.
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.
Winegar
Angela L
AL
College of Pharmacy, University of Texas at Austin, University Station, A1900, Austin, TX 78712, USA.
Shepherd
Marvin D
MD
Lawson
Kenneth A
KA
Richards
Kristin M
KM
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