Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer.
Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer.
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过渡到 Medicare D 部分对患有癌症的双重参保者获得药物治疗的影响。
DOI：
10.1016/j.jval.2017.05.023
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Griggs,JenniferJ
中科院分区：
文献类型：
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作者：
Adams,AlyceS;Madden,JeanneM;Zhang,Fang;Lu,ChristineY;Ross-Degnan,Dennis;Lee,Angelina;Soumerai,StephenB;Gilden,Dan;Chawla,Neetu;Griggs,JenniferJ
目的 评估从 Medicaid 过渡到 Medicare D 部分药物覆盖范围对癌症双重参保者使用非癌症治疗的影响。方法我们利用美国所有付费服务双重参保者的 5% 代表性全国样本（2004-2007 年）来评估取消上限对 D 部分下每月可报销处方数量（药物上限）对 1）患病率和 2）平均值的影响抗抑郁药、抗高血压药和降脂药的总体供应天数和种族（白人和黑人）。结果 药物上限的取消与降脂药物的使用增加相关（供应天数 3.63；95% 置信区间 [CI] 1.57–5.70）。在限制州的黑人中，我们观察到降脂疗法（任何使用增加 0.08 个百分点；95% CI 0.05–0.10；供应天数 4.01；95% CI 2.92–5.09）和抗抑郁药物（天数供应 2.20；95% CI 0.61–3.78）的使用增加，以及抗高血压药物使用的增加趋势（任何使用） 0.01 个百分点；95% CI 0.004–0.01；供应天数 1.83；95% CI 1.25–2.41）。使用降脂药物的白人与黑人差距立即缩小（-0.09 个百分点；95% CI -0.15 至 -0.04）。我们还观察到抗高血压药物使用（水平-0.08个百分点；95% CI -0.12至-0.05；趋势-0.01个百分点；95% CI -0.02至-0.01）和抗抑郁药使用（-0.004个百分点；95% CI -0.01至-0.0004）的白人与黑人差异扩大趋势出现逆转。研究结果表明，D 部分取消药物上限对高胆固醇血症的整体治疗影响不大，并且可能减少了降脂和抗抑郁药物使用中的黑白差距。
ObjectivesTo evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer.MethodsWe leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United States (2004–2007) to evaluate the impact of the removal of caps on the number of reimbursable prescriptions per month (drug caps) under Part D on 1) prevalence and 2) average days’ supply dispensed for antidepressants, antihypertensives, and lipid-lowering agents overall and by race (white and black).ResultsThe removal of drug caps was associated with increased use of lipid-lowering medications (days’ supply 3.63; 95% confidence interval [CI] 1.57–5.70). Among blacks in capped states, we observed increased use of lipid-lowering therapy (any use 0.08 percentage points; 95% CI 0.05–0.10; and days’ supply 4.01; 95% CI 2.92–5.09) and antidepressants (days’ supply 2.20; 95% CI 0.61–3.78) and increasing trends in antihypertensive use (any use 0.01 percentage points; 95% CI 0.004–0.01; and days’ supply 1.83; 95% CI 1.25–2.41). The white-black gap in the use of lipid-lowering medications was immediately reduced (−0.09 percentage points; 95% CI −0.15 to −0.04). We also observed a reversal in trends toward widening white-black differences in antihypertensive use (level −0.08 percentage points; 95% CI −0.12 to −0.05; and trend −0.01 percentage points; 95% CI −0.02 to −0.01) and antidepressant use (−0.004 percentage points; 95% CI −0.01 to −0.0004).ConclusionsOur findings suggest that the removal of drug caps under Part D had a modest impact on the treatment of hypercholesterolemia overall and may have reduced white-black gaps in the use of lipid-lowering and antidepressant therapies.
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影响因子：
--
作者：
Ashley Wilder Smith;B. Reeve;Keith M Bellizzi;L. Harlan;C. Klabunde;M. Amsellem;A. Bierman;R. Hays
通讯作者：
Ashley Wilder Smith;B. Reeve;Keith M Bellizzi;L. Harlan;C. Klabunde;M. Amsellem;A. Bierman;R. Hays
影响因子：
6.2
作者：
Joeëlle Y. Friedman;L. Curtis;B. Hammill;J. Dhillon;Charles H. Weaver;Sugata Biswas;A. Abernethy;K. Schulman
通讯作者：
K. Schulman
影响因子：
120.7
作者：
Tammemagi, CM;Nerenz, D;Nathanson, D
通讯作者：
Nathanson, D
影响因子：
25.8
作者：
Madden JM;Adams AS;LeCates RF;Ross-Degnan D;Zhang F;Huskamp HA;Gilden DM;Soumerai SB
通讯作者：
Soumerai SB
药物福利和药物使用的非线性定价：医疗保险 D 部分中他汀类药物合规性的案例。
影响因子：
3.4
作者：
Kyoungrae Jung;R. Feldman;A. McBean
通讯作者：
A. McBean