{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Jung J"],"funding":["NICHD NIH HHS","NIA NIH HHS","National Institute on Aging"],"pagination":["4371-4380"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC6232437"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["53(6)"],"pubmed_abstract":["OBJECTIVES:To examine variation in risk-adjusted reinsurance payments across Part D plans, analyze its implications for the program, and explore options to reduce reinsurance payments. DATA/STUDY DESIGN:2007-2015 Part D Plan Payment and Premium data; 2010-2013 Part D Prescription Drug Event data; and 2013 Part D Plan Formulary Files. PRINCIPAL FINDINGS:Risk-adjusted reinsurance payments varied widely across plans at a given out-of-pocket (OOP) premium. The variance in risk-adjusted reinsurance in common OOP premium ranges increased between 2010 and 2015. High risk-adjusted reinsurance payments were negatively correlated with use of utilization management tools for high-cost drugs. CONCLUSIONS:Growing reinsurance payments shrink plans' liability for managing drug spending for high-cost enrollees, creating plan moral hazard, and making OOP premiums a noisy signal of plans' total costs."],"journal":["Health services research"],"pubmed_title":["Growing Reinsurance Payments Weaken Competitive Bidding in Medicare Part D."],"pmcid":["PMC6232437"],"funding_grant_id":["R01 AG047934","1R01AG047934‐01","P2C HD041025"],"pubmed_authors":["Jung J","Feldman R"],"additional_accession":[]},"is_claimable":false,"name":"Growing Reinsurance Payments Weaken Competitive Bidding in Medicare Part D.","description":"OBJECTIVES:To examine variation in risk-adjusted reinsurance payments across Part D plans, analyze its implications for the program, and explore options to reduce reinsurance payments. DATA/STUDY DESIGN:2007-2015 Part D Plan Payment and Premium data; 2010-2013 Part D Prescription Drug Event data; and 2013 Part D Plan Formulary Files. PRINCIPAL FINDINGS:Risk-adjusted reinsurance payments varied widely across plans at a given out-of-pocket (OOP) premium. The variance in risk-adjusted reinsurance in common OOP premium ranges increased between 2010 and 2015. High risk-adjusted reinsurance payments were negatively correlated with use of utilization management tools for high-cost drugs. CONCLUSIONS:Growing reinsurance payments shrink plans' liability for managing drug spending for high-cost enrollees, creating plan moral hazard, and making OOP premiums a noisy signal of plans' total costs.","dates":{"release":"2018-01-01T00:00:00Z","publication":"2018 Dec","modification":"2025-04-05T09:52:53.832Z","creation":"2025-04-05T09:52:53.832Z"},"accession":"S-EPMC6232437","cross_references":{"pubmed":["29736940"],"doi":["10.1111/1475-6773.12866"]}}