Characteristics of Medicare Part D beneficiaries who reach the drug benefit threshold in both of the first two years of the Part D benefit.
Characteristics of Medicare Part D beneficiaries who reach the drug benefit threshold in both of the first two years of the Part D benefit.
复制标题
在 D 部分福利的前两年达到药物福利阈值的 Medicare D 部分受益人的特征。
DOI：
10.1097/mlr.0b013e3181ca2824
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发表时间：
2010
期刊：
影响因子：
3
通讯作者：
Raebel,MarshaA
中科院分区：
文献类型：
--
作者：
Bayliss,ElizabethA;Ellis,JenniferL;Delate,Thomas;Steiner,JohnF;Raebel,MarshaA
背景：达到药物受益阈值（DBT）的医疗保险D部分受益人有不良健康后果的风险。目的：我们探讨在医疗保险D部分的前2年内反复达到DBT的受益人的临床特征，并可能受益于药物和护理管理的主动识别。研究设计：回顾性队列。受试者：25，320名医疗保险优势受益人，其中536人仅在2006年达到DBT，（“仅2006年”）; 2006年和2007年，有961人达到了残疾人基本治疗标准（“两个年度”）;两个年度均为23，823人。我们反复评估达到DBT（仅相对于2006年）作为人口统计、发病率（具体情况和总体负担）、药物使用（具体类别和总体负担）、利用率以及灾难性和/或额外的药房福利的使用。在多变量分析中，他们比2006年唯一的一组更有可能患有5种疾病中的一种或多种（慢性肺病、痴呆、抑郁症、尿失禁和帕金森病），在这些情况下更有可能使用有限的通用替代品的商品名药物。结论：反复达到DBT是疾病负担的程度和慢性程度的函数，其特征在于通用药物可用性有限的情况，以及相关的常见合并症。如果这些发现得到证实，在实践和政策层面的策略可能会帮助这些医疗保险受益人避免不必要的自付费用的药物过早达到DBT。
Background:Medicare Part D beneficiaries who reach the drug benefit threshold (DBT) risk adverse health outcomes.Objectives:We explore clinical characteristics of beneficiaries who repeatedly reach the DBT during the first 2 years of Medicare Part D and may benefit from proactive identification for medication and care management.Research Design:Retrospective cohort.Subjects:25,320 Medicare Advantage beneficiaries of whom 536 reached the DBT in 2006 only,(“2006 only”); 961 reached the DBT in 2006 and 2007 (“both years”); and 23,823 in neither year.Measures:We assessed repeatedly reaching the DBT (relative to 2006 only) as a function of demographics, morbidity (specific conditions and overall burden), medication use (specific classes and overall burden), utilization, and use of catastrophic and/or additional pharmacy benefits.Results:Those who reached the DBT in both years had higher morbidity and utilization. In multivariate analyses, they were more likely than the 2006 only group to have one or more of 5 conditions (chronic pulmonary disease, dementia, depression, incontinence, and Parkinson disease), and within these conditions were more likely to use categories of trade-name medications for which there are limited available generic alternatives.Conclusions:Repeatedly reaching the DBT is a function of the extent and chronicity of disease burden and is characterized by conditions for which there is limited availability of generic medications, and associated common comorbidities. If these findings are confirmed, strategies at practice and policy levels may help such Medicare beneficiaries avoid unnecessary out of pocket expenditures on medications from prematurely reaching the DBT.