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PHP42 PHYSICIANS' VIEWS REGARDING PRESCRIPTION DRUG ACCESS UNDER MEDICARE PART D
Abstracts ity, income, education and the lack of vertical equity in preventive care may be an indication of sub-optimal resource allocation in the US population. PHP41 PATIENT RACE AND MEDICATION CHOICE FOR HYPERCHOLESTEROLEMIA, HYPERTENSION, AND DIABETES
Rathore SS1, Alexander GC2, Ketcham JD3, Epstein AJ1 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes. We consider whether these differences reflect physicians’ prescribing decisions. METHODS: Data from an ongoing webbased survey of 2,200 randomly-selected primary care physicians in 4 states were used to assess the role of patient race in prescription decisions. Physicians viewed 3 clinical vignettes (hypercholesterolemia, hypertension, diabetes) consisting of a patient photo and text, provided medication recommendations, and estimated treatment compliance using a 10-point Likert scale (1—definitely not comply, 10—definitely comply). Patient race (black, white) was randomly assigned at the respondent level; other factors were held constant. We compared medication recommendations and compliance estimates by patient race for each vignette using Fisher chi-square analysis and t-tests. RESULTS: Data from 229 respondents (1942 eligible, 11.8% response rate) were available at time of submission; 118 respondents were randomized to black patients, 111 to white patients. Black and white patients were equally likely to receive a prescription in the hypercholesterolemia (99.2% black vs. 100.0% white, P = 1.00), diabetes (99.2% black vs. 99.2% white, P = 1.00) and hypertension (99.2% black vs. 100.0% white, P = 1.00) vignettes. Hypertension treatment recommendations differed by race; black patients were less likely to be prescribed an ACE inhibitor (43.0% vs. 71.3%) and more likely to be prescribed a calcium channel blocker (19.3% vs. 2.8%, overall P < 0.001). Mean levels of estimated compliance were similar by race in the hypercholesterolemia (black 7.2 vs. white 7.3, P = 0.56) and diabetes (black 7.6 vs. white 7.7, P = 0.44) vignettes, but trended lower for the black patient in the hypertension vignette (7.4 vs. white 7.7, P = 0.06). CONCLUSION: These preliminary data indicate patient race may influence physicians’ choice of drug class and estimates of compliance in patients with hypertension, but has no measurable effect on the decision to initiate treatment for hypertension, hypercholesterolemia or diabetes. PHP42 PHYSICIANS’ VIEWS REGARDING PRESCRIPTION DRUG ACCESS UNDER MEDICARE PART D
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: To assess primary care physicians’ attitudes regarding the impact of Medicare Part D on beneficiaries’ access to prescription drugs. METHODS: We used data from an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas to analyze respondents’ views of Part D. Physicians were contacted by mailed invitation and offered a cash honorarium for participation. RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. When asked “Overall, what is your impression of Part D?” 46% (105/229) of physicians responded “somewhat favorable” or “very favorable,” while 36% (93/ 229) responded “somewhat unfavorable” or “very unfavor-
A41 able.” Most respondents (63%, 140/221) felt Part D formularies were insufficient for their patients’ needs, but a majority (51%, 111/216) believed patients’ access to prescription drugs had improved under Part D. Physicians reported patients with no prior prescription drug coverage had better access to drugs under Part D (83%, 190/229), while patients with prior prescription drug coverage experienced worse access (49%, 113/229). Physicians varied in their views regarding the impact of Part D on access to drugs for minority patients; 19% (44/229) reported access was worse, 44% (101/229) reported access was unchanged, 37% (84/229) reported accessed improved. Most physicians reported requesting prior authorization for Part D patients in the prior 30 days (86%, 196/229), and changing a prescription in the past 30 days because their preferred medication was not covered by a Part D formulary (93%, 214/229). CONCLUSION: These preliminary data indicate physicians have mixed opinions about Medicare Part D. Although many physicians believe Part D has improved access to prescription drug coverage, especially for those without prior coverage, current Part D formularies were considered insufficient and frequently required physicians to request prior authorization or prescribe a non-preferred medication. PHP43 PHYSICIANS’ VIEWS REGARDING THE IMPACT OF MEDICARE PART D DRUG COVERAGE FOR DUAL-ELIGIBLE PATIENTS
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Drug coverage for dual-eligible patients switched from Medicaid to Medicare Part D in January, 2006. We assessed primary care physicians’ current beliefs regarding the impact of the switch on dual-eligible patients and physicians, and examined possible differences based on the restrictiveness of states’ Medicaid drug coverage. METHODS: In an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas, respondents were asked how aspects of drug access changed under Part D relative to pre-Part D Medicaid coverage. Physicians were contacted by mail and offered a cash honorarium for participation. Chi-square tests compared responses between physicians in states with less-restrictive Medicaid drug coverage (NC) and states with more-restrictive Medicaid coverage (FL, MA, TX). RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. Findings are reported as percentages of respondents indicating a feature was worse/unchanged/better under Part D relative to Medicaid. Most respondents reported dual-eligible patients’ access to drugs (54/22/24%) and satisfaction (61/23/ 16%) were worse in Part D, but patient compliance (29/61/ 10%) was unchanged. Most physicians also reported their ability to prescribe preferred medications (60/29/11%) and administrative burden of writing prescriptions (56/30/15%) were worse in Part D. Findings differed by the restrictiveness of states’ Medicaid drug coverage. Respondents from NC were more likely to report Part D was worse than Medicaid for: dual-eligible patients’ access to medications (72/20/9% vs. 43/23/35%, P < 0.001), satisfaction (77/17/6% vs. 50/27/23%, P < 0.001), and compliance (40/55/5% vs. 21/65/14%, P = 0.008); and physicians’ prescribing preferred drugs (80/20/0% vs. 47/35/18%, P < 0.001) and administrative burden (80/ 17/2% vs. 38/38/23%, P < 0.001). CONCLUSION: These preliminary data indicate physicians believe Medicare Part D has adversely affected dual-eligible patients previously covered under Medicaid. The transition to Part D coverage for dual-
Rathore SS1, Alexander GC2, Ketcham JD3, Epstein AJ1 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes. We consider whether these differences reflect physicians’ prescribing decisions. METHODS: Data from an ongoing webbased survey of 2,200 randomly-selected primary care physicians in 4 states were used to assess the role of patient race in prescription decisions. Physicians viewed 3 clinical vignettes (hypercholesterolemia, hypertension, diabetes) consisting of a patient photo and text, provided medication recommendations, and estimated treatment compliance using a 10-point Likert scale (1—definitely not comply, 10—definitely comply). Patient race (black, white) was randomly assigned at the respondent level; other factors were held constant. We compared medication recommendations and compliance estimates by patient race for each vignette using Fisher chi-square analysis and t-tests. RESULTS: Data from 229 respondents (1942 eligible, 11.8% response rate) were available at time of submission; 118 respondents were randomized to black patients, 111 to white patients. Black and white patients were equally likely to receive a prescription in the hypercholesterolemia (99.2% black vs. 100.0% white, P = 1.00), diabetes (99.2% black vs. 99.2% white, P = 1.00) and hypertension (99.2% black vs. 100.0% white, P = 1.00) vignettes. Hypertension treatment recommendations differed by race; black patients were less likely to be prescribed an ACE inhibitor (43.0% vs. 71.3%) and more likely to be prescribed a calcium channel blocker (19.3% vs. 2.8%, overall P < 0.001). Mean levels of estimated compliance were similar by race in the hypercholesterolemia (black 7.2 vs. white 7.3, P = 0.56) and diabetes (black 7.6 vs. white 7.7, P = 0.44) vignettes, but trended lower for the black patient in the hypertension vignette (7.4 vs. white 7.7, P = 0.06). CONCLUSION: These preliminary data indicate patient race may influence physicians’ choice of drug class and estimates of compliance in patients with hypertension, but has no measurable effect on the decision to initiate treatment for hypertension, hypercholesterolemia or diabetes. PHP42 PHYSICIANS’ VIEWS REGARDING PRESCRIPTION DRUG ACCESS UNDER MEDICARE PART D
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: To assess primary care physicians’ attitudes regarding the impact of Medicare Part D on beneficiaries’ access to prescription drugs. METHODS: We used data from an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas to analyze respondents’ views of Part D. Physicians were contacted by mailed invitation and offered a cash honorarium for participation. RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. When asked “Overall, what is your impression of Part D?” 46% (105/229) of physicians responded “somewhat favorable” or “very favorable,” while 36% (93/ 229) responded “somewhat unfavorable” or “very unfavor-
A41 able.” Most respondents (63%, 140/221) felt Part D formularies were insufficient for their patients’ needs, but a majority (51%, 111/216) believed patients’ access to prescription drugs had improved under Part D. Physicians reported patients with no prior prescription drug coverage had better access to drugs under Part D (83%, 190/229), while patients with prior prescription drug coverage experienced worse access (49%, 113/229). Physicians varied in their views regarding the impact of Part D on access to drugs for minority patients; 19% (44/229) reported access was worse, 44% (101/229) reported access was unchanged, 37% (84/229) reported accessed improved. Most physicians reported requesting prior authorization for Part D patients in the prior 30 days (86%, 196/229), and changing a prescription in the past 30 days because their preferred medication was not covered by a Part D formulary (93%, 214/229). CONCLUSION: These preliminary data indicate physicians have mixed opinions about Medicare Part D. Although many physicians believe Part D has improved access to prescription drug coverage, especially for those without prior coverage, current Part D formularies were considered insufficient and frequently required physicians to request prior authorization or prescribe a non-preferred medication. PHP43 PHYSICIANS’ VIEWS REGARDING THE IMPACT OF MEDICARE PART D DRUG COVERAGE FOR DUAL-ELIGIBLE PATIENTS
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Drug coverage for dual-eligible patients switched from Medicaid to Medicare Part D in January, 2006. We assessed primary care physicians’ current beliefs regarding the impact of the switch on dual-eligible patients and physicians, and examined possible differences based on the restrictiveness of states’ Medicaid drug coverage. METHODS: In an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas, respondents were asked how aspects of drug access changed under Part D relative to pre-Part D Medicaid coverage. Physicians were contacted by mail and offered a cash honorarium for participation. Chi-square tests compared responses between physicians in states with less-restrictive Medicaid drug coverage (NC) and states with more-restrictive Medicaid coverage (FL, MA, TX). RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. Findings are reported as percentages of respondents indicating a feature was worse/unchanged/better under Part D relative to Medicaid. Most respondents reported dual-eligible patients’ access to drugs (54/22/24%) and satisfaction (61/23/ 16%) were worse in Part D, but patient compliance (29/61/ 10%) was unchanged. Most physicians also reported their ability to prescribe preferred medications (60/29/11%) and administrative burden of writing prescriptions (56/30/15%) were worse in Part D. Findings differed by the restrictiveness of states’ Medicaid drug coverage. Respondents from NC were more likely to report Part D was worse than Medicaid for: dual-eligible patients’ access to medications (72/20/9% vs. 43/23/35%, P < 0.001), satisfaction (77/17/6% vs. 50/27/23%, P < 0.001), and compliance (40/55/5% vs. 21/65/14%, P = 0.008); and physicians’ prescribing preferred drugs (80/20/0% vs. 47/35/18%, P < 0.001) and administrative burden (80/ 17/2% vs. 38/38/23%, P < 0.001). CONCLUSION: These preliminary data indicate physicians believe Medicare Part D has adversely affected dual-eligible patients previously covered under Medicaid. The transition to Part D coverage for dual-