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June 01, 2008 at 04:00 PM
A new final regulation could help the Center for Medicare & Medicaid Services learn whether ready access to prescriptions really cuts overall health care costs.
The CMS, an arm of the U.S. Department of Health and Human Services, has released a final rule governing the collection and sharing of Medicare Part D prescription drug program claims data.
The new final rule, scheduled to take effect June 27, will apply to all Part D program claims data collected since Jan. 1, 2006, when the program began operating, CMS officials write in a preamble to the proposed final rule, which appears today in the Federal Register.
The CMS based the final rule on a draft released in October 2006. The draft rule attracted 116 comments from members of the public, officials report.
The final regulations permit the secretary of Health and Human Services to gather and share a wide variety of claims data, including pieces of information such as the patient’s date of birth and gender, the date care was provided, the identity of the Part D sponsor and Part D plan, the date the claim was paid, the identity of the pharmacy that filled the prescription, and an indication of whether the patient has reached the “donut hole.”
The donut hole is the gap between a Part D plan’s routine coverage limit and the start of catastrophic prescription benefits.
The final rule requires HHS to take steps to protect personal information.
But HHS will be able share the data with researchers in such a way that, in some cases, the researchers will be able to correlate drug plan claims information for specific patients with Medicare Part A hospitalization claims and Medicare Part B physician and outpatient services claims for the same patients.
Combining the claims data “will enable the secretary to analyze the prescription drug utilization of chronically ill patients over time, and determine whether increases in prescription utilization do, in fact, result in fewer hospitalizations,” officials write in the preamble.
Congress created the Part D program, in the Medicare Prescription Drug, Improvement and Modernization Act of 2003, partly to see whether some Medicare patients were ending up in the hospital because they could not afford the drugs used in preventive care efforts, officials write.
