Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
复制标题
患有糖尿病的低收入医疗保险受益人放弃处方药补贴的后果。
DOI：
10.1111/1475-6773.13990
复制
发表时间：
2022
影响因子：
3.4
通讯作者：
Roberts,EricT
中科院分区：
文献类型：
--
作者：
Glynn,Alexandra;Hernandez,Inmaculada;Roberts,EricT
目的目的是估计患有糖尿病的医疗保险受益人中医疗保险D部分低收入补贴（LIS）的使用情况，并检查LIS登记者和符合LIS资格的非登记者之间的自付费用和处方药使用差异。LIS降低了低收入受益人的自付药物费用;然而，并非所有符合LIS条件的个人都参加了研究。LIS的采用以及糖尿病受益人放弃这一益处的后果仍然未知。健康与退休研究链接到2008年至2016年的医疗保险管理数据。研究设计我们在糖尿病受益人中进行了两项分析。首先，我们估计了按收入分层的LIS使用率（≤ 100%的联邦贫困水平FPL和> 100%至≤ 150%的FPL）。其次，为了评估在接近贫困的受益人（收入> FPL的100%至≤ 150%）中放弃LIS的后果，我们进行了倾向评分加权回归分析，以比较LIS登记者和LIS合格的非登记者之间的自付费用，处方药使用和与费用相关的药物不依从性。数据收集/数据提取N/A。在患有糖尿病的医疗保险受益人中，68.1%的收入> 100%至≤ 150% FPL的人接受了LIS，而90.3%的收入≤ 100% FPL的人接受了LIS。在接近贫困的受益人中，符合LIS条件的非登记者的年度自付药物支出更高（518; 95inUSD %CI：370 inUSD，667 inUSD; p <0.001），糖尿病、高血压和高血压药物的处方量减少7.3（95%CI：− 11.1，− 3.5; p <0.001），8.9个百分点更可能报告因费用而跳过药物（95%CI：0.3，18.0; p = 0.04），均与LISenrollees.Conclusions尽管提供实质性的财政援助与处方药费用，LISs是在患有慢性疾病的患者中使用，需要使用麻醉药品。Aspolicymakers讨论了PartDreform以解决自付药物成本的上升，他们应该制定策略，增加参与现有计划，减轻低收入医疗保险受益人的成本负担。
Objective The objective is to estimate the take‐up of the Medicare Part D Low‐Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out‐of‐pocket costs and prescription drug use between LIS enrollees and LIS‐eligible non‐enrollees. The LIS reduces out‐of‐pocket drug costs for low‐income beneficiaries; however, not all LIS‐eligible individuals are enrolled. Take‐up of the LIS, and consequences of forgoing this benefit among beneficiaries with diabetes, remains unknown. Data Sources Health and Retirement Study linked to Medicare administrative data from 2008 to 2016. Study Design We conducted two analyses among beneficiaries with diabetes. First, we estimated LIS take‐up stratified by income (≤ 100% of the Federal Poverty Level FPL and> 100% to≤ 150% of FPL). Second, to assess the consequences of forgoing the LIS among near‐poor beneficiaries (incomes> 100% to≤ 150% of FPL), we conducted propensity score‐weighted regression analyses to compare out‐of‐pocket costs, the prescription drug use, and cost‐related medication non‐adherence among LIS enrollees and LIS‐eligible non‐enrollees. Data Collection/Data Extraction N/A. Principal Findings Among Medicare beneficiaries with diabetes, 68.1% of those with incomes> 100% to≤ 150% of FPL received the LIS, while 90.3% with incomes≤ 100% of FPL received the LIS. Among near‐poor beneficiaries, LIS‐eligible non‐enrollees incurred higher annual out‐of‐pocket drug spending (518;95inUSD%CI: 370 in USD, 667inUSD;p<0.001),filled7.3fewerprescriptionsfordiabetes,hypertension,andhyperlipidemiadrugs(95%CI:−11.1,−3.5;p<0.001),andwere8.9percentagepointsmorelikelytoreportskippingdrugsduetocost(95%CI:0.3,18.0;p=0.04),allcomparedtoLISenrollees.ConclusionsDespiteprovidingsubstantialfinancialassistancewithprescriptiondrugcosts,theLISisunder‐utilizedamongbeneficiarieswithchronicconditionsrequiringroutinemedicationuse.AspolicymakersdiscussPartDreformstoaddressrisingout‐of‐pocketdrugcosts,theyshouldconsiderstrategiestoincreaseparticipationinexistingprogramsthatalleviatecostburdensamonglow‐incomeMedicarebeneficiaries.