Adequacy of Prescription Drug Coverage in Long-term Care.
Adequacy of Prescription Drug Coverage in Long-term Care.
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DOI：
10.1097/mlr.0000000000001291
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发表时间：
2020-05
期刊：
影响因子：
3
通讯作者：
Koethe B
中科院分区：
文献类型：
--
作者：
Briesacher B;Oliveri-Mui B;Chhabra B;Koethe B
负担得起的药物获取对于长期护理（LTC）的医疗保险参保者来说很重要，然而，目前尚不清楚处方药的覆盖范围是否普遍，是否足以满足他们的高药物需求。我们评估了2011-2013年期间处方药覆盖率，自付（OOP）支付和药物使用的全国LTC数据库中的处方水平，居民水平和设施水平的数据。药物覆盖不足定义为OOP支付的药物≥ 50%。风险调整广义估计方程模型进行了估计，以确定预测不足的药物覆盖面和总处方填充。一个全国性的332,087名医疗保险登记者的样本在LTC中观察到> 100天。我们发现医疗保险D部分是药物覆盖的主要来源（82.4%），其次是私人保险（8.5%）和退伍军人管理局（0.2%）。8.9%（n = 29，378）的人支付所有药物OOP或仅接受临时药物支付援助，无法检测到药物覆盖。另有2，721人的药物覆盖率不足。没有药物保险或有私人保险的LTC Medicare登记者收到的处方明显少于参加Medicare Part D的人。在LTC中，很大一部分医疗保险登记者的药物覆盖不足或没有覆盖，并且接受的药物少于其健康需求所示。医疗保险D部分是一项重要政策，以确保在LTC中获得负担得起的药物。然而，需要扩大，以增加入学率和减少药物覆盖不足。
Affordable access to medications is important to Medicare enrollees in long-term care (LTC), yet, it is unknown if prescription drug coverage is universal and adequate to meet their high medication needs. We assessed enrollment in prescription drug coverage, out-of-pocket (OOP) payments and medication use in a nationwide LTC database of prescription-level, resident-level, and facility-level data for the period 2011–2013. Inadequate drug coverage was defined as ≥ 50% medications paid for OOP. Risk-adjusted generalized estimation equations models were estimated to identify predictors of inadequate drug coverage and total prescription fills. A nationwide sample of 332,087 Medicare enrollees observed > 100 days in LTC. We found Medicare Part D was the main source of drug coverage (82.4%), followed by private insurance (8.5%), and Veterans Administration (0.2%). No drug coverage could be detected for 8.9% (n = 29,378) who paid for all of their medications OOP or received only temporary drug payment assistance. Inadequate drug coverage was identified in another 2721 persons. LTC Medicare enrollees without drug coverage or who had private insurance received significantly fewer prescriptions than if they had been enrolled in Medicare Part D. A substantial proportion of Medicare enrollees in LTC have inadequate or no drug coverage and are receiving less medication than indicated by their health needs. Medicare Part D is an important policy for ensuring affordable access to medications in LTC. However, expansions are needed to increase enrollment and decrease inadequate drug coverage.