Date of Award

1-1-2020

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Amy J. Davidoff

Abstract

The original Medicare Part D benefit included a gap in coverage, commonly known as the “doughnut hole,” where beneficiaries were responsible for 100% of drug costs. The Affordable Care Act included provisions to gradually close this gap, beginning in 2011, in order to reduce the financial burden of drug spending for Part D enrollees. Using a nationally representative survey of Medicare beneficiaries, we examined the effect of this policy on out-of-pocket drug spending and medication affordability. We found that the policy was associated with a decrease in out-of-pocket spending. However, this trend was limited to relatively healthy enrollees in stand-alone Part D plans. Surprisingly, measures of medication affordability worsened after closure of the coverage gap. These results highlight persistent problems of medication affordability in the Part D program and underscore the need for policy makers to further address the financial burden posed by medication costs.

Open Access

This Article is Open Access

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