Who enrolls in the Medicare Part D prescription drug benefit program? Medication use among patients with heart failure.
Who enrolls in the Medicare Part D prescription drug benefit program? Medication use among patients with heart failure.
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DOI：
10.1161/jaha.113.000242
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发表时间：
2013-09-11
影响因子：
5.4
通讯作者：
Curtis LH
中科院分区：
文献类型：
--
作者：
Eapen ZJ;Hammill BG;Setoguchi S;Schulman KA;Peterson ED;Hernandez AF;Curtis LH
现在可以获得医疗保险D部分独立处方药计划的配药数据，但心力衰竭登记者的特征尚未得到很好的描述。截至2010年1月1日，我们在全国代表性的5%医疗保险受益人样本中确定了81874例流行性心力衰竭患者。我们根据截至2010年1月1日的Medicare Part D计划的登记情况对患者进行分类。按入组状态比较人口统计学特征、共病情况和处方。截至1月1日，共有49252人（60.2%）参加了Medicare Part D计划。入学者往往是妇女、黑人和社会经济地位较低的人。与血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂或醛固酮拮抗剂相比，心力衰竭入组者更常使用袢利尿剂处方。在2010年前4个月，5 444人（12.3%）达到了覆盖缺口，566人（1.3%）需要超过差距的灾难性覆盖。患有心力衰竭的医疗保险受益人根据D部分处方药计划的入组情况存在显著差异，并且代表了临床疗效试验中代表性不足的人群。许多人面临着覆盖缺口，很少有人选择医疗保险D部分计划，在差距提供覆盖。将医疗保险D部分事件数据与临床登记联系起来可以帮助确定符合条件的登记者是否因心力衰竭而治疗不足。
Dispensing data from Medicare Part D standalone prescription drug plans are now available, but characteristics of enrollees with heart failure have not been well described. We identified 81 874 patients with prevalent heart failure as of January 1, 2010, in a nationally representative 5% sample of Medicare beneficiaries. We classified patients according to enrollment in a Medicare Part D plan as of January 1, 2010. Demographic characteristics, comorbid conditions, and prescriptions were compared by enrollment status. A total of 49 252 (60.2%) were enrolled in a Medicare Part D plan as of January 1. Enrollees were more often women, black, and of lower socioeconomic status. Enrollees with heart failure more often filled prescriptions for loop diuretics than angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, β‐blockers, or aldosterone antagonists. During the first 4 months of 2010, 5444 (12.3%) reached the coverage gap, and 566 (1.3%) required catastrophic coverage beyond the gap. Medicare beneficiaries with heart failure differ significantly according to enrollment in Part D prescription drug plans and represent a population underrepresented in clinical efficacy trials. Many face the coverage gap, and few select Medicare Part D plans that provide coverage during the gap. Linking Medicare Part D event data with clinical registries could help to determine whether eligible enrollees are undertreated for heart failure.