CMS Issues Rule To Provide Researchers With Limited Access to Medicare Prescription Drug Benefit Claims
CMS has issued a rule that will provide researchers with access to hundreds of millions of Medicare prescription drug benefit claims but will limit their studies of the commercial parts of the program, CQ HealthBeat reports.According to a "fact sheet" issued by CMS on May 22, the rule will allow researchers to study the safety and effectiveness of medications among the elderly and disabled, as clinical trials "often exclude the very old, patients with multiple chronic conditions and those taking multiple medications, comprising the vast majority of Medicare beneficiaries." The rule also will allow Medicare beneficiaries to use the claims data to update their personal health records with the medications that they take, CMS said.
However, under the rule, the identities of specific Medicare prescription drug plans will remain "encrypted," CMS said. CMS also will combine cost information for Medicare prescription drug plans because to "do otherwise could negatively affect the ability of plans to negotiate prices favorable to beneficiaries and taxpayers," according to the agency. CMS also said that agency officials will develop guidelines and workshops to inform researchers about how to access the claims data.
Tricia Neuman, a Kaiser Family Foundation vice president and director of the Medicare Policy Project at the foundation, said, "Researchers are chomping at the bit to get more information about Part D plans, and the release of these data is good news," adding, "However, it appears that data restrictions will limit how much we'll be able to learn about the experiences of people in specific plans." Researchers will not have the ability to determine the relationship between the amount of the rebates that Medicare prescription drug plans receive from pharmaceutical companies and the amount that they charge beneficiaries, Neuman said.
In addition, the rule will allow researchers to determine the number of Medicare beneficiaries who reach the so-called "doughnut hole" coverage gap, although not for specific prescription drug plans, CQ HealthBeat reports (Reichard, CQ HealthBeat, 6/10). This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
