Growing Reinsurance Payments Weaken Competitive Bidding in Medicare Part D

Jeah Jung, Roger D Feldman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: To examine variation in risk-adjusted reinsurance payments across Part D plans, analyze its implications for the program, and explore options to reduce reinsurance payments. Data/Study Design: 2007–2015 Part D Plan Payment and Premium data; 2010–2013 Part D Prescription Drug Event data; and 2013 Part D Plan Formulary Files. Principal Findings: Risk-adjusted reinsurance payments varied widely across plans at a given out-of-pocket (OOP) premium. The variance in risk-adjusted reinsurance in common OOP premium ranges increased between 2010 and 2015. High risk-adjusted reinsurance payments were negatively correlated with use of utilization management tools for high-cost drugs. Conclusions: Growing reinsurance payments shrink plans’ liability for managing drug spending for high-cost enrollees, creating plan moral hazard, and making OOP premiums a noisy signal of plans’ total costs.

Original languageEnglish (US)
Pages (from-to)4371-4380
Number of pages10
JournalHealth services research
Volume53
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Competitive Bidding
Medicare Part D
Formularies
Costs and Cost Analysis
Drug Costs
Prescription Drugs
Pharmaceutical Preparations

Keywords

  • Part D reinsurance
  • competitive bidding
  • plan moral hazard

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

Cite this

Growing Reinsurance Payments Weaken Competitive Bidding in Medicare Part D. / Jung, Jeah; Feldman, Roger D.

In: Health services research, Vol. 53, No. 6, 01.12.2018, p. 4371-4380.

Research output: Contribution to journalArticle

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