Cost-related Medication Nonadherence and Its Risk Factors Among Medicare Beneficiaries.
Cost-related Medication Nonadherence and Its Risk Factors Among Medicare Beneficiaries.
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DOI：
10.1097/mlr.0000000000001458
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发表时间：
2021-01
期刊：
影响因子：
3
通讯作者：
Madden JM
中科院分区：
文献类型：
--
作者：
Nekui F;Galbraith AA;Briesacher BA;Zhang F;Soumerai SB;Ross-Degnan D;Gurwitz JH;Madden JM
负担不起的药物是有效治疗的障碍。费用相关不依从性(CRN)是衡量药物可获得性的一个重要且被广泛使用的指标。我们的研究调查了目前美国联邦医疗保险人群中CRN的全国患病率和风险因素(例如，不填充、跳过或减少剂量)和配套措施。调查加权分析包括Logistic回归和2006-2016年的趋势。主要分析使用了2016年联邦医疗保险当前受益人调查。我们的研究样本为12,625人，代表了5600万社区居民受益人。其他成果措施减少了其他必需品的支出，以便支付药品费用和使用诸如申请仿制药等降低药品成本的战略。2016年，34.5%的65岁以下残疾参与者和14.4%的65岁及以上参与者由于高昂的费用而没有按处方服药；19.4%和4.7%的人分别经历了没有其他必需品来支付药品费用。收入15-25K美元的接近贫困的老年受益人患CRN的几率高出50%(VS&>；50K美元)，但收入&15K美元的受益人更有可能获得D部分低收入补贴，其风险并没有显著增加。健康恶化的三个指标(一般健康状况、功能极限和病情计数)都独立地与CRN的更高风险相关。自D部分以来，CRN风险概况的变化反映了有针对性的政策的有效性。CRN的持续流行和医疗保险中病情较重的人的相关风险表明，处方配药的高成本分担的后果。
Unaffordability of medications is a barrier to effective treatment. Cost-related nonadherence (CRN) is a crucial, widely used measure of medications access. Our study examines the current national prevalence of and risk factors for CRN (e.g., not filling, skipping or reducing doses) and companion measures in the US Medicare population. Survey-weighted analyses included logistic regression and trends 2006–2016. Main analyses used the 2016 Medicare Current Beneficiary Survey. Our study sample of 12,625 represented 56 million community-dwelling beneficiaries. Additional outcome measures were spending less on other necessities in order to pay for medicines and use of drug cost reduction strategies such as requesting generics. In 2016, 34.5% of enrollees under 65 years with disability and 14.4% of those 65 years and older did not take their medications as prescribed due to high costs; 19.4% and 4.7%, respectively, experienced going without other essentials to pay for medicines. Near-poor older beneficiaries with incomes $15–25K had 50% higher odds of CRN (vs >$50K), but beneficiaries with incomes <$15K, more likely to be eligible for the Part D Low-Income Subsidy, did not have significantly higher risk. Three indicators of worse health (general health status, functional limits, and count of conditions) were all independently associated with higher risk of CRN. Changes in the risk profile for CRN since Part D reflect the effectiveness of targeted policies. The persistent prevalence of CRN and associated risks for sicker people in Medicare demonstrate the consequences of high cost-sharing for prescription fills.