Impact of Cost Sharing on Therapeutic Substitution: The Story of Statins in 2006.
Impact of Cost Sharing on Therapeutic Substitution: The Story of Statins in 2006.
复制标题
费用分摊对治疗替代的影响：2006 年他汀类药物的故事。
DOI：
10.1161/jaha.116.003377
复制
发表时间：
2016
影响因子：
5.4
通讯作者：
Doshi,JalpaA
中科院分区：
文献类型：
--
作者：
Li,Pengxiang;Schwartz,JSanford;Doshi,JalpaA
研究背景费用分担被广泛用于鼓励治疗替代。本研究的目的是探讨增加患者的成本分摊差异的品牌和仿制药对他汀类药物的利用进入医疗保险D部分覆盖gap.Method和ResultsUsing 5%的医疗保险慢性病仓库文件从2006年的影响，这项准实验研究检查了高脂血症患者谁填补处方阿托伐他汀或瑞舒伐他汀之间的2006年1月至3月。使用倾向评分匹配和差异中差异回归来比较研究组（不符合低收入补贴[非LIS]条件且仅具有通用缺口覆盖的患者）与对照组（在D部分覆盖缺口之前和期间面临相同费用分摊的LIS患者）他汀类药物使用的变化。在最终样本中，研究组的801名患者与对照组的801名患者相匹配。我们发现，与对照组相比，研究组每月使用任何品牌他汀类药物的下降幅度更大（-0.2430天填充量，P<0.001）。这只是部分抵消了增加每月通用他汀类药物的使用（+0.06 30天填充，P<0.001），与整体下降，在任何每月他汀类药物的使用（-0.18 30天填充，P<0.001）。与对照组相比，研究组他汀类药物的总体依从性下降（OR 0.81，P <0.001），他汀类药物停药增加（OR 1.62，P <0.001）。结论：在医保D部分高脂血症患者中，品牌药和仿制药在覆盖缺口条目上的成本分摊差异增加与他汀类药物停药相关。
BackgroundCost sharing is widely used to encourage therapeutic substitution. This study aimed to examine the impact of increases in patient cost‐sharing differentials for brand name and generic drugs on statin utilization on entry into the Medicare Part D coverage gap.Method and ResultsUsing 5% Medicare Chronic Condition Warehouse files from 2006, this quasi‐experimental study examined patients with hyperlipidemia who filled prescriptions for atorvastatin or rosuvastatin between January and March 2006. Propensity score matching and difference‐in‐difference regressions were used to compare changes in statin utilization for the study group (patients who were not eligible for low‐income subsidies [non–LIS] and had generic‐only gap coverage) to those of a control group (LIS patients who faced the same cost sharing before and during the Part D coverage gap). In the final sample, 801 patients in the study group were matched to 801 patients in the control group. We found that, compared to the control group, the study group had a larger decline in any monthly brand‐name statin use (−0.24 30‐day fills,P<0.001). This was only partially offset by increased monthly generic statin use (+0.06 30‐day fill,P<0.001), with an overall drop in any monthly statin use (−0.18 30‐day fills,P<0.001). Overall adherence with statins declined (OR 0.81,P<0.001), and statin discontinuation increased (OR 1.62,P<0.001) in the study group as compared to the control group.ConclusionsIncreases in cost‐sharing differentials for brand name and generic drugs on coverage gap entry were associated with discontinuation of statins in Medicare Part D patients with hyperlipidemia.