Evaluation of the Medicare Part D Prescription Drug Benefit
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created the first-ever prescription drug benefit under the Medicare Program. This drug benefit, which took effect on January 1, 2005, is called Medicare Part D and is offered to all eligible beneficiaries. Using its unique Medicare-Medicaid integrated database, JAI is able to evaluate the impact of Part D on Medicare and Medicaid beneficiaries.

National Evaluation of Medicare Part D on Medicare Beneficiaries with Eligibility for Medicaid
JAI has developed a Medicare Part D evaluation system specifically designed for Medicaid programs to examine how access to prescription drugs and health outcomes under Part D have changed for Medicare beneficiaries with eligibility for coverage under the Medicaid program (or “dual eligibles.”)

JAI has developed a multi-dimensional analysis and evaluation of the Medicare Part D program using its fully-integrated Medicare-Medicaid database. Examples of the evaluation are described below:

Treatment Disruptions: JAI examines whether dually eligible members with specific chronic diseases are being effectively served with the combination of prescription drug benefits provided by the state prescription program and Medicare Part D. This analysis determines if such treatment disruptions have occurred in their therapeutic treatments and possibly require a response or intervention on the part of the state, prescription drug plan, or federal government.

Premium and Risk Assessment: Because of Medicare Part D, policymakers are concerned that the enrollment of high-risk, dual-eligible populations in low-premium Part D plans may lead to financial vulnerability on this high-risk population. Additionally, the effect of low premiums collected from non-duals implies a limited capacity on the part of a plan to cross subsidize shortfalls associated with higher than expected costs by the dually eligible population. JAI examines the effects of automatically enrolling dually-eligible Part D members on the premiums paid to prescription drug plans for the Medicare Part D program.

Identifying Potential Disruption of Pharmacy Benefits for High-Risk Beneficiaries covered under Medicare Part D
JAI is able to assist states to make the transition from a state-funded prescription drug plan to coverage under Medicare Part D.

Prior to the implementation of Medicare Part D, many states opted to operate and finance state prescription drug benefits in addition to the prescription drug benefits through the Medicaid program. Today, several of these prescription drug programs funded by states continue to serve as a secondary insurer to the Medicare Part D prescription drug benefit or the primary insurer of prescription drugs for members who are not eligible for benefits under Medicare Part D. Many of these states are examining the effect of Medicare Part D on these members.

JAI has developed a comprehensive database and corresponding analysis: (1) to respond to inquiries on how members would be affected by shifting the responsibility of prescription drug benefits from state-funded programs to Medicare Part D program; and (2) to identify the most vulnerable populations of prescription drug users and any disruptions in drug regimens when Medicare Part D commenced on January 1, 2006.

Learn more