Research Get Limited Access to Medicare Drug Claims
Lately there has been a rush to access various personal and confidential medical records for research purposes. The latest information being requested is Medicare prescription drug benefit claims.
The Centers for Medicare and Medicaid Services (CMS) has issued a ruling allowing researchers access to records for only specific purposes. They will be able to study the effectiveness and safety of medication used by elderly and disabled Medicare recipients.
One of the reasons that researchers want to try to explore this information is that elderly and chronically ill patients are often not included in clinical trials and the information that can be obtained through Medicare could help study results of specific medications.
CMS has stated that under the rules, the information regarding the individuals and the identities of prescription drug plans will not be accessible and will remain encrypted. CMS will also combine cost information for Medicare prescription drug plans because not doing so “could negatively affect the ability of plans to negotiate medications, favorable to Medicare beneficiaries and taxpayers.”
There will also be regulations to guide research in what they can do and what they cannot when it comes to the research they are working on. The Kaiser Family Foundation has said that the release of this information is a good thing. Researchers will not have the ability to access certain claims data, nor will it be able to discover the amount of rebates that Medicare prescription drug plans receive from pharmaceutical companies and the amount they charge beneficiaries.
One important part of the research will be allowing researches to determine how many beneficiaries reach the “donut hole” amount where there is a gap in prescription coverage, but they will not be able to identify which plan they are enrolled in. Determining the gap in coverage at the “donut hole” may help many avoid financial traps in the future by identifying a way to avoid that trap.
In some respects, if handled appropriately, this research can certainly be helpful to many parties involved.
