title: Out-of-plan medication in Medicare Part D.
abstract: OBJECTIVE
  To determine the extent to which Medicare Part D enrollees fill unadjudicated prescriptions for diabetes, hypertension, and hyperlipidemia medications outside of the Part D benefit.
  
  
  METHODS
  Retrospective analysis of prescriptions filled by community-dwelling beneficiaries continually enrolled in a Medicare Part D plan in 2009.
  
  
  METHODS
  We used the Medicare Current Beneficiary Survey to compare self-reported prescription fills for oral antidiabetes medications, renin-angiotensin-aldosterone system inhibitors, and statins to adjudicated prescription drug event data recorded by Part D plan sponsors. For unadjudicated prescriptions with no evidence of Part D payment, we determined whether the fills were paid for in cash, filled through VA pharmacies or discount generic programs, or had other reported sources of coverage.
  
  
  RESULTS
  A total of 6.2% of all prescriptions filled by Part D beneficiaries were unadjudicated, ranging from 5.3% of all oral antidiabetes medications to 6.8% of statins. Cash prescriptions accounted for more than half of all out-of-plan use, but we found little evidence of unadjudicated out-of-plan use of discount generics. Prescriptions filled at VA pharmacies and those with other reported sources of coverage each accounted for about 1% of total fills.
  
  
  CONCLUSIONS
  Out-of-plan medication use accounts for a small share of total prescriptions filled by Part D beneficiaries. Nevertheless, CMS should continue to work with plan sponsors to develop initiatives that facilitate the collection of beneficiaries' complete utilization data, as a more complete reporting could improve the quality of care delivered to Part D enrollees.
authors.affiliation: 220 Arch St, Baltimore, MD 21201. E-mail: pamroberto@umaryland.edu.
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Roberto
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents