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Association of Part D Coverage Gap With COPD Medication Adherence
Yanni F. Yu, DSc, MA, MS; Larry R. Hearld, PhD; Haiyan Qu, PhD; Midge N. Ray, PhD; and Meredith L. Kilgore, PhD
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Association of Part D Coverage Gap With COPD Medication Adherence

Yanni F. Yu, DSc, MA, MS; Larry R. Hearld, PhD; Haiyan Qu, PhD; Midge N. Ray, PhD; and Meredith L. Kilgore, PhD
Using longitudinal Medicare claims data, this study quantified the association of the Medicare Part D coverage gap with medication adherence among beneficiaries with chronic obstructive pulmonary disease.
Findings from this study revealed that reaching the Part D coverage gap is associated with lower odds of medication adherence among Medicare beneficiaries with COPD. Building on these results, additional research related to other important illnesses or other meaningful outcomes will be pertinent for increasing the knowledge base in this area, improving current benefit design, and optimizing the quality of health policy decisions to help Medicare provide optimal healthcare for its members with cost-effective outcomes.

Author Affiliations: Boehringer-Ingelheim Pharmaceuticals, Inc (YFY), Ridgefield, CT; School of Health Professions (LRH, HQ, MNR) and Ryals School of Public Health (MLK), University of Alabama at Birmingham, Birmingham, AL.
Source of Funding: None.
Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (YFY, LRH, HQ, MLK); acquisition of data (YFY, HQ, MLK); analysis and interpretation of data (YFY, LRH, HQ, MNR, MLK); drafting of the manuscript (YFY, HQ, MNR); critical revision of the manuscript for important intellectual content (YFY, LRH, MNR, MLK); statistical analysis (YFY, LRH, MLK); administrative, technical, or logistic support (YFY, MLK); and supervision (LRH, MNR). 
Address Correspondence to: Yanni F. Yu, DSc, Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Rd, Ridgefield, CT 06877. E-mail:

1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease website. Updated 2015. Accessed June 2016.

2. Hoyert DL, Xu J. Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012:61(6):1-51.

3. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;61(46):938-943.

4. American Thoracic Society, European Respiratory Society. Standards for the diagnosis and management of patients with COPD. American Thoracic Society website. Published 2004. Accessed October 2014.

5. IMS Health. Medicare Part D: the first year. Informa Business Intelligence Inc website. Published 2007. Accessed October 2014.

6. Hoadley J, Thompson J, Hargrave E, Merrell K, Cubanski J, Neuman T. Medicare Part D 2008 data spotlight: the coverage gap. Kaiser Family Foundation website. Published November 2007. Accessed October 30, 2014.

7. Polinski JM, Shrank WH, Huskamp HA, Glynn RJ, Liberman JN, Schneeweiss S. Changes in drug utilization during a gap in insurance coverage: an examination of the Medicare Part D coverage gap. PLoS Med. 2011;8(8):e1001075. doi: 10.1371/journal.pmed.1001075.

8. Jung K, Feldman R, McBean AM. Nonlinear pricing in drug benefits and medication use: the case of statin compliance in Medicare Part D. Health Serv Res. 2014;49(3):910-928. doi: 10.1111/1475-6773.12145.

9. Polinski JM, Shrank WH, Glynn RJ, Huskamp HA, Roebuck MC, Schneeweiss S. Beneficiaries with cardiovascular disease and the Part D coverage gap. Circ Cardiovasc Qual Outcomes. 2012;5(3):387-395. doi: 10.1161/CIRCOUTCOMES.111.964866.

10. Zeng F, Patel BV, Brunetti L. Effects of coverage gap reform on adherence to diabetes medications. Am J Manag Care. 2013;19(4):308-316.

11. Gu Q, Zeng F, Patel BV, Tripoli LC. Part D coverage gap and adherence to diabetes medications. Am J Manag Care. 2010;16(12):911-918.

12. Fung V, Price M, Busch AB, et al. Adverse clinical events among Medicare beneficiaries using antipsychotic drugs: linking health insurance benefits and clinical needs. Med Care. 2013;51(7):614-621. doi: 10.1097/MLR.0b013e31829019c5.

13. Nair KV, Frech-Tamas F, Jan S, Wolfe P, Allen RR, Saseen JJ. Comparing pre-gap and gap behaviors for Medicare beneficiaries in a Medicare managed care plan. J Health Care Finance. 2011;38(2):38-53.

14. Stuart B, Davidoff A, Erten M, et al. How Medicare Part D benefit phases affect adherence with evidence-based medications following acute myocardial infarction. Health Serv Res. 2013;48(6, pt 1):1960-1977. doi: 10.1111/1475-6773.12073.

15. Simoni-Wastila L, Wei YJ, Qian J, et al. Association of chronic obstructive pulmonary disease maintenance medication adherence with all-cause hospitalization and spending in a Medicare population. Am J Geriatr Pharmacother. 2012;10(3):201-210. doi: 10.1016/j.amjopharm.2012.04.002.

16. Ismaila A, Corriveau D, Vaillancourt J, et al. Impact of adherence to treatment with tiotropium and fluticasone propionate/salmeterol in chronic obstructive pulmonary diseases patients. Curr Med Res Opin. 2014;30(7):1427-1436. doi: 10.1185/03007995.2014.908828.

17. Schneeweiss S, Rassen JA, Glynn RJ, Avorn J, Mogun H, Brookhart MA. High-dimensional propensity score adjustment in studies of treatment effects using health care claims data. Epidemiology. 2009;20(4):512-522. doi: 10.1097/EDE.0b013e3181a663cc.

18. Rassen JA, Glynn RJ, Brookhart MA, Schneeweiss S. Covariate selection in high-dimensional propensity score analyses of treatment effects in small samples. Am J Epidemiol. 2011;173(12):1404-1413. doi: 10.1093/aje/kwr001.

19. Parsons LS. Reducing bias in a propensity score matched-pair sample using greedy matching techniques. Poster presented at: SAS User Group International Conference; 2009; Seattle, WA. Accessed March 2015.

20. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13-22. doi: 10.1093/biomet/73.1.13

21. Hardin JW, Hilbe JM. Generalized Estimating Equations. London, UK: Chapman and Hall/CRC; 2003.

22. Normand ST, Landrum MB, Guadagnoli E, et al. Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores. J Clin Epidemiol. 2001;54(4):387-398.

23. Fung V, Mangione CM, Huang J, et al. Falling into the coverage gap: Part D drug costs and adherence for Medicare Advantage prescription drug plan beneficiaries with diabetes. Health Serv Res. 2010;45(2):355-375. doi: 10.1111/j.1475-6773.2009.01071.x.

24. Zhang Y, Baik SH, Lave JR. Effects of Medicare Part D coverage gap on medication adherence. Am J Manag Care. 2013;19(6):e214-e224.

25. Baik SH, Rollman BL, Reynolds CF 3rd, Lave JR, Smith KJ, Zhang Y. The effect of the US Medicare Part D coverage gaps on medication use among patients with depression and heart failure. J Ment Health Policy Econ. 2012;15(3):105-118.

26. Joyce GF, Zissimopoulos J, Goldman DP. Digesting the doughnut hole. J Health Econ. 2013;32(6):1345-1355. doi: 10.1016/j.jhealeco.2013.04.007.

27. Einav L, Finkelstein A, Schrimpf P. The response of drug expenditure to non-linear contract design: evidence from Medicare Part D. Q J Econ. 2015;130(2):841-899.

28. Kaplan C, Zhang Y. The January effect: medication reinitiation among Medicare Part D beneficiaries. Health Econ. 2014;23(11):1287-1300. doi: 10.1002/hec.2981. 
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