Differential Effects by Mental Health Status of Filling the Medicare Part D Coverage Gap.
Differential Effects by Mental Health Status of Filling the Medicare Part D Coverage Gap.
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DOI：
10.1097/mlr.0000000000001668
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发表时间：
2022-02-01
期刊：
影响因子：
3
通讯作者：
Kaplan CM
中科院分区：
文献类型：
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作者：
Liu J;Zhang Y;Kaplan CM
研究保险福利设计的变化对老年精神障碍患者用药的影响。2007年至2018年美国医疗保险索赔数据。利用从2011年开始逐步消除的医疗保险处方药覆盖差距，我们用差异中的差异方法研究了药物类型对药物使用和自付支出的影响。我们通过精神障碍来确定亚群，并比较心理健康组和一般医疗保险人群的估计。缩小这一差距大大减少了个人的自付支出，对于那些精神障碍更严重的人来说，减少的幅度更大。该政策导致医保人群（0.91，P<0.01, 12.12%增加）、重度精神障碍受益人（2.71，P<0.01, 11.13%增加）和普通精神障碍受益人（2.63，P<0.01, 11.62%增加）使用品牌药的比例显著增加，而对阿尔茨海默氏症和痴呆症（AD）受益人的影响则明显较小（0.44，P<0.01, 1.83%）。另一方面，该政策使所有群体的仿制药使用量减少了约3-5%。总体而言，没有精神疾病的受益人在覆盖差距缩小后，总药物使用有统计学意义上的显著增加（2.05%），而所有三个精神健康组在总调解使用方面要么没有统计学意义上的显著变化，要么略有减少（AD, - 1.26%）。患者对价格变化的反应因精神障碍和药物类型而异。对AD患者使用品牌药物的影响尤其小。我们的研究结果表明，降低药物成本对不同疾病有不同的影响，可能不足以提高对所有疾病的依从性，特别是那些患有严重精神健康障碍（如AD）的人。
To study how changes in insurance benefit design affect medication use of older adults with mental disorders. US Medicare claims data from 2007 to 2018. Exploiting the gradual elimination of the Medicare prescription drug coverage gap beginning in 2011, we examine the effects on medication use and out-of-pocket spending by drug type with a difference-in-differences approach. We identify subpopulations by mental disorder and compare the estimates across mental health groups and to the general Medicare population. Closing the gap substantially reduced individuals’ out-of-pocket spending, and the reduction was larger for those with more severe mental disorders. The policy led to a statistically significant increase in branded drugs used for Medicare population (0.91; P<0.01; 12.12% increase), beneficiaries with severe mental disorders (2.71; P<0.01; 11.13% increase) and common mental disorders (2.63; P<0.01; 11.62% increase), whereas such effect for beneficiaries with Alzheimer’s and dementia (AD) is substantially smaller (0.44; P<0.01; 1.83%). On the other hand, the policy decreased generic drugs used by about 3-5% for all groups. Overall, beneficiaries without mental health illness have a statistically significant increase in total medication use (2.05%) following the coverage gap closure, while all three mental health groups have either no statistically significant changes or a small reduction in total mediation use (AD, −1.26%). Patients’ responses to price changes vary across mental disorders and by drug type. The impact on branded drug utilization among those with AD is particularly small. Our findings suggest that lowering medication costs has differential impacts across diseases and may not be sufficient to improve adherence for all conditions, in particular those with severe mental health disorders such as AD.