In addition to cost concerns, the program is monitoring the quality of drug prescribing. According to a Fund-supported study, prescription rates for antipsychotic medications are increasing, with more than one of four Medicare beneficiaries in nursing homes receiving antipsychotics between 2000 and 2001.⁽⁷⁾ This study, led by Becky Briesacher, Ph.D., raised questions regarding the appropriateness of prescribing. With Medicare preparing to assume Medicaid's role in covering prescriptions for the nursing home population, the time is ripe to evaluate prescribing guidelines and current use of antipsychotic drugs.

The Fund will continue to monitor the implementation of the new prescription drug benefit and its effect on the accessibility, quality, and cost of the medicines beneficiaries need. To this end, program work will explore the drug utilization patterns of Medicare beneficiaries with 10 conditions that have been singled out by federal officials as requiring special attention. As the Medicare prescription drug benefit changes the landscape of retiree health benefits, the Fund will collect information on employer behavior regarding retirees in response to these changes.

The MMA greatly expands the role of private health plans in Medicare: the prescription drug benefit is available solely through private plans, and the legislation substantially increases payments to private plans for care provided in the Medicare Advantage (MA) program. As reported in a December 2004 issue brief, Brian Biles, M.D., and colleagues estimated that extra payments to MA plans total $2.72 billion, or an average of $546 more than fee-for-service costs for each of the 5 million enrollees.⁽⁸⁾ A Fund grant enabled Robert Berenson, M.D., to examine the structure of payments to private insurers. In a Health Affairs Web Exclusive article, he said that Congress must consider whether extra payments to private plans might be better used to benefit all Medicare beneficiaries.⁽⁹⁾ The Fund will continue to explore the implications of Medicare Advantage for the Medicare program and its beneficiaries.