Falling into the coverage gap: Part D drug costs and adherence for Medicare Advantage prescription drug plan beneficiaries with diabetes.
Falling into the coverage gap: Part D drug costs and adherence for Medicare Advantage prescription drug plan beneficiaries with diabetes.
复制标题
陷入承保缺口：D 部分药品费用以及患有糖尿病的 Medicare Advantage 处方药计划受益人的遵守情况。
DOI：
10.1111/j.1475-6773.2009.01071.x
复制
发表时间：
2010
影响因子：
3.4
通讯作者：
Hsu,John
中科院分区：
文献类型：
--
作者：
Fung,Vicki;Mangione,CarolM;Huang,Jie;Turk,Norman;Quiter,ElaineS;Schmittdiel,JulieA;Hsu,John
目的。比较 2006 年标准 D 部分承保缺口与补充缺口承保范围的 Medicare 受益人的药品费用和依从性。数据来源。来自 Medicare Advantage 处方药 (MAPD) 计划的药房数据。研究设计。并行分析比较有缺口与无缺口的综合 MAPD 中 65 岁以上患有糖尿病的受益人 (n=28,780)；在网络模型 MAPD 中，有缺口的受益人与缺口期间仅仿制药的覆盖率相比 (n=14,984)。主要发现。有缺口的受益人与完全或仅仿制药缺口覆盖的受益人相比，药品支出分别低 3%（95% 置信区间 [CI]：1-4%）和 4%（CI：1-6%）。有间隙的患者与无间隙的患者相比，自付费用高出 189%（CI：185-193%），并且对三种慢性药物类别的依从性较低（例如，对于口服糖尿病药物，比值比 = 0.83，CI：0.79-0.88）。有缺口的受益人与纯仿制药缺口承保的受益人相比，年度自付费用高出 14%（CI：10-17%），但依从性水平相似。结论。在患有糖尿病的 Medicare 受益人中，D 部分承保缺口导致总药品成本较低，但与没有缺口相比，自付费用较高，依从性较差。与没有缺口承保相比，在缺口期间仅承保仿制药似乎带来的好处有限。
Objective.To compare drug costs and adherence among Medicare beneficiaries with the standard Part D coverage gap versus supplemental gap coverage in 2006.Data Sources.Pharmacy data from Medicare Advantage Prescription Drug (MAPD) plans.Study Design.Parallel analyses comparing beneficiaries aged 65+ with diabetes in an integrated MAPD with a gap versus no gap (n=28,780); and in a network‐model MAPD with a gap versus generic‐only coverage during the gap (n=14,984).Principal Findings.Drug spending was 3 percent (95 percent confidence interval [CI]: 1–4 percent) and 4 percent (CI: 1–6 percent) lower among beneficiaries with a gap versus full or generic‐only gap coverage, respectively. Out‐of‐pocket expenditures were 189 percent higher (CI: 185–193 percent) and adherence to three chronic drug classes was lower among those with a gap versus no gap (e.g., odds ratio=0.83, CI: 0.79–0.88, for oral diabetes drugs). Annual out‐of‐pocket spending was 14 percent higher (CI: 10–17 percent) for beneficiaries with a gap versus generic‐only gap coverage, but levels of adherence were similar.Conclusions.Among Medicare beneficiaries with diabetes, having the Part D coverage gap resulted in lower total drug costs, but higher out‐of‐pocket spending and worse adherence compared with having no gap. Having generic‐only coverage during the gap appeared to confer limited benefits compared with having no gap coverage.