How Medicare decides prescription drug coverage
Tradeoffs in the Design of Medicare Prescription Drug Coverage
['FUNDING_P01'] · HARVARD MEDICAL SCHOOL · NIH-11416705
This project looks at different ways Medicare covers prescription drugs to find which options help older people afford and get the medicines they need.
Quick facts
| Phase | ['FUNDING_P01'] |
|---|---|
| Study type | Nih_funding |
| Sex | All |
| Sponsor | HARVARD MEDICAL SCHOOL (nih funded) |
| Locations | 1 site (BOSTON, UNITED STATES) |
| Trial ID | NIH-11416705 on ClinicalTrials.gov |
What this research studies
From a patient's point of view, researchers will analyze Medicare prescription and claims data to compare broad (universal) coverage changes versus targeted help for specific groups. They will examine how cost-sharing, prior authorization, step therapy, and formulary limits affect medication use and out-of-pocket costs. The team will focus on differences across subgroups such as people with multiple chronic conditions, low-income beneficiaries, and those living in rural areas. Using statistical models and policy simulations, they will estimate which coverage designs reduce medication gaps for which patients.
Who could benefit from this research
Good fit: This is most relevant to Medicare beneficiaries, especially older adults with chronic illnesses, low income, or limited local access to providers.
Not a fit: People who are not on Medicare—for example younger adults with private insurance or the uninsured—are unlikely to see direct benefits from these specific findings.
Why it matters
Potential benefit: If successful, this work could inform Medicare policies that make prescriptions more affordable and accessible for people with chronic conditions.
How similar studies have performed: Prior studies have shown that cost-sharing and administrative barriers influence medication use, but directly comparing universal versus targeted coverage across patient subgroups is a newer, less-tested policy approach.
Where this research is happening
BOSTON, UNITED STATES
- HARVARD MEDICAL SCHOOL — BOSTON, UNITED STATES (ACTIVE)
Researchers
- Principal investigator: LAYTON, TIMOTHY — HARVARD MEDICAL SCHOOL
- Study coordinator: LAYTON, TIMOTHY
About this research
- This is an active NIH-funded research project — typically early-stage science, not a clinical trial accepting patient enrollment.
- Some NIH-funded labs run parallel clinical studies or seek volunteers for related work. To check, contact the principal investigator or institution listed above.
- For full project details, budget, and progress reports, visit the official NIH RePORTER page below.
Conditions: Chronic Disease