Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011.
Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011.
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DOI：
10.1097/mlr.0000000000000205
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发表时间：
2014-11
期刊：
影响因子：
3
通讯作者：
Madden JM
中科院分区：
文献类型：
--
作者：
Naci H;Soumerai SB;Ross-Degnan D;Zhang F;Briesacher BA;Gurwitz JH;Madden JM
有资格获得医疗保险的残疾美国人通常患有多种慢性疾病，高度依赖有效的药物治疗，并且财务资源有限，使他们面临与成本相关的药物不依从性（CRN）的风险。自2006年以来，D部分福利帮助医疗保险受益人负担得起药物。调查按发病率负担分层的这一弱势人群中药物负担能力的近期全国趋势。我们使用多变量logistic回归分析，估计了一项全国代表性调查（2006-2011年，n = 14，091人-年）中非老年残疾参与者的药物负担能力年比率。调查报告的CRN和支出较少的其他基本需要，以负担得起的药品。在D部分实施后的六年中，报告CRN的残疾医疗保险受益人比例从31.6%到35.6%不等，而报告的其他基本需求支出较少的患病率从17.7%到21.8%不等。在整个研究年中，那些患有多种慢性疾病的人的负担能力问题一直更糟。2011年，患有三种或三种以上疾病的残疾受益人中CRN的流行率为37.3%，而患有较少疾病的残疾受益人中CRN的流行率为28.1%;对于基本需求支出较少的残疾受益人，CRN的流行率分别为25.4%和15.7%。2011年与2007年相比，这两项指标都没有统计学上可检测到的变化。残疾医疗保险受益人继续努力负担处方药。迫切需要对这一弱势群体给予集中的政策关注，尽管医疗保险D部分涵盖了药物，但他们没有足够的资金获得药物治疗。
Disabled Americans who qualify for Medicare coverage typically have multiple chronic conditions, are highly dependent on effective drug therapy, and have limited financial resources, putting them at risk for cost-related medication nonadherence (CRN). Since 2006, the Part D benefit has helped Medicare beneficiaries afford medications. To investigate recent national trends in medication affordability among this vulnerable population, stratified by morbidity burden. We estimated annual rates of medication affordability among nonelderly disabled participants in a nationally representative survey (2006–2011, n = 14,091 person-years) using multivariate logistic regression analyses. Survey-reported CRN and spending less on other basic needs to afford medicines. In the six years following Part D implementation, the proportion of disabled Medicare beneficiaries reporting CRN ranged from 31.6% to 35.6%, while the reported prevalence of spending less on other basic needs to afford medicines ranged from 17.7% to 21.8%. Across study years, those with multiple chronic conditions had consistently worse affordability problems. In 2011, the prevalence of CRN was 37.3% among disabled beneficiaries with three or more morbidities as compared to 28.1% among those with fewer morbidities; for spending less on basic needs, the prevalence was 25.4% versus 15.7%, respectively. There were no statistically detectable changes in either measure when comparing 2011 to 2007. Disabled Medicare beneficiaries continue to struggle to afford prescription medications. There is an urgent need for focused policy attention on this vulnerable population, which has inadequate financial access to drug treatments, despite having drug coverage under Medicare Part D.