Dissertation Title: "Three Studies on Policies to Reduce Medicare Drug Spending"
This thesis consists of three related studies on policies to reduce prescription drug spending by Medicare beneficiaries. The policy context is the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The first study, "Savings from Drug Discount Cards: Relief for Medicare Beneficiaries?" estimates savings for Medicare beneficiaries without drug coverage from prescription drug discount card programs. I estimate modest average savings from existing programs of 17.4 percent over current retail prices. Savings through the federally-approved Medicare discount card program will depend on beneficiaries' out-of-pocket drug spending, the number and types of drugs used, and specific card program features. Aggregate savings estimates vary widely, based on uncertainty in discounts and program participation rates.
The second study, "Antihypertensive Prescription Drug Use by Medicare Beneficiaries: What Factors Relate to Demand for Generics?" evaluates demand for antihypertensive generic drugs by Medicare beneficiaries. Increasing use of generic drugs could restrain growth in drug spending, because generics are generally cheaper than brand-name drugs. This could be particularly helpful for Medicare beneficiaries who currently lack insurance coverage for prescription drugs and pay full retail price. Using Medicare Current Beneficiary Survey data from 2000, I examine whether beneficiaries' demand for generic antihypertensive drugs is related to variation in coverage for supplemental medical insurance and outpatient prescription drugs, usual source of medical care, income, health status measures, and state laws that require substituting generic drugs for brand-name equivalents. Results show that the design of insurance arrangements and the care-giving environment are important factors in beneficiaries' demand for generic antihypertensive drugs.
The third study, "When Policy and Press Collide: Analyzing Media Coverage of the Medicare Prescription Drug Discount Card Program," analyzes the content of print media to systematically assess how four influential newspapers covered the development and implementation of the Medicare discount card program from July 2003 to June 2004. The tone of coverage-positive, negative, or neutral-has practical and political implications for beneficiaries, industry groups, government officials, policymakers, and ultimately, the program itself. The analysis indicates that media coverage of the discount card program has conveyed an increasingly critical tone since enactment of the MMA.