title: Medicare Part D roulette: potential implications of random assignment and plan restrictions.
abstract: BACKGROUND
  Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown.
  
  
  OBJECTIVE
  We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan.
  
  
  METHODS
  Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary's medications on plan formulary) were calculated for each benchmark plan.
  
  
  RESULTS
  Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions.
  
  
  CONCLUSIONS
  Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance.
authors.affiliation: University of the Pacific-Pharmacy Practice.
authors.forename: Rajul A
authors.initials: RA
authors.lastname: Patel
authors.affiliation: University of the Pacific-Pharmacy Practice.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Walberg
authors.affiliation: University of the Pacific-Pharmacy Practice.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Woelfel
authors.affiliation: University of the Pacific-Economics.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Amaral
authors.affiliation: St. Joseph's Medical Center-Medicine.
authors.forename: Paresh
authors.initials: P
authors.lastname: Varu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D002140:California; D004608:Eligibility Determination; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data; D054524:Medicare Part D / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D011897:Random Allocation; D014481:United States
keywords: Medicaid; Medicare Part D; benchmark plans; drug utilization restrictions; dual-eligible; prescription drug costs
references.citation: Health Aff (Millwood). 2006 May-Jun;25(3):707-19
references.pmid: 16684735
references.citation: Inquiry. 2006 Spring;43(1):66-76
references.pmid: 16838819
references.citation: Clin Infect Dis. 2010 Sep 15;51(6):718-24
references.pmid: 20695800