Identifying Cost and Coverage Barriers to Medicare Beneficiary Access to Specialty Drugs

The researcher team will document the relationship between specialty drug prices, treatment uptake, and health outcomes for Medicare beneficiaries from 2010 through early 2019 in three ways. First, they will document price changes, Part D formulary coverage, and expected out‐of‐pocket costs for specialty drugs. Data will be obtained from the Medicare Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files made available by the Centers for Medicare and Medicaid Services. Second, the team will identify the frequency of unfilled or delayed filling of prescriptions and seek to determine the impact of relevant factors, including out‐of‐pocket costs and prices. Third, the team will examine the association between unfilled or delayed filling of prescriptions and health service use, survival, and Medicare spending. For these last two aims, the team will link electronic health record data to Medicare fee‐for‐service claims and Part D data.