Medicare beneficiaries' knowledge, attitudes, and perceptions (KAP) of the Medicare Part D prescription drug benefit have been under evaluation since the 2006 inception of the Part D benefit.

This is the first study to compare total Medicare Part D (MPD) stand-alone prescription drug plan (PDP) estimated annual costs (EAC) between 2007 and 2008 in all MPD regions of the US using a patient cohort of Medicare-eligible patients. A total of 50 patients were selected at random from a database of Medicare-eligible patients. Each patient profile, based on pharmacy claims data, was entered into the Medicare website and the EAC of each PDP in each of the 34 MPD regions was obtained. The lowest, 25th percentile, median and highest EAC plans were obtained for each patient in each region for 2007 and 2008. Pair-wise, within-region, between-year comparisons were made using the Wilcoxon Signed-Ranks test. Annual trends were variable between MPD regions. Only the highest EAC showed significant decreases in some regions, while all other comparisons showed no change or an increase in regional costs. Out-of-pocket Medicare prescription drug costs increased from 2007 to 2008. Increases in plan costs highlight the need for annual re-evaluation of PDP costs so that the patient is able to obtain the lowest cost plan each year. The decrease in the highest cost plan may suggest improvements in formulary coverage.

BACKGROUND: The substitution of generic treatment alternatives for brand-name drugs is a strategy that can help lower Medicare beneficiary out-of-pocket costs. Beginning in 2011, Medicare beneficiaries reaching the coverage gap received a 50% discount on the full drug cost of brand-name medications and a 7% discount on generic medications filled during the gap. This discount will increase until 2020, when beneficiaries will be responsible for 25% of total drug costs during the coverage gap. OBJECTIVE: To examine the cost variability of brand and generic drugs within 4 therapeutic classes before and during the coverage gap for each 2011 California stand-alone prescription drug plan (PDP) and prospective coverage gap costs in 2020 to determine the effects on beneficiary out-of-pocket drug costs. METHODS: Equivalent doses of brand and generic drugs in the following 4 pharmacological classes were examined: angiotensin II receptor blockers (ARBs), bisphosphonates, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). The full drug cost and patient copay/coinsurance amounts during initial coverage and the coverage gap of each drug was recorded based on information retrieved from the Medicare website. These drug cost data were recorded for 28 California PDPs. RESULTS: The highest cost difference between a brand medication and a Centers for Medicare Medicaid Services (CMS)-suggested generic treatment alternative varied between $110.53 and $195.49 at full cost and between $51.37 and $82.35 in the coverage gap. The lowest cost difference varied between $38.45 and $76.93 at full cost and between -$4.11 and $18.52 during the gap. CONCLUSION: Medicare beneficiaries can realize significant out-of-pocket cost savings for their drugs by taking CMS-suggested generic treatment alternatives. However, due to larger discounts on brand medications made available through recent changes reducing the coverage gap, the potential dollar savings by taking suggested generic treatment alternatives during the gap is less compelling and will decrease as subsidies increase.