Impact of Medicare Drug Benefit on Use and Cost-related Underuse of Medicines

医疗保险药物福利对药物使用和与成本相关的药物使用不足的影响

• 批准号: 7136408
• 负责人: STEPHEN B SOUMERAI
• 金额: $ 33.94万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-15 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7136408
• 关键词: Medicare /Medicaid; behavioral /social science research tag; diabetes mellitus; drug /agent; health behavior; health care cost /financing; health care service utilization; health services research tag; human data; human old age (65+); hypertension; longitudinal human study; low socioeconomic status

DESCRIPTION (provided by applicant): Millions of elderly Americans lack economic access to essential medications due to insufficient insurance coverage. The Medicare Modernization Act of 2003 (MMA) will allow Medicare beneficiaries to purchase a prescription drug benefit (Part D), beginning in January 2006. Additional subsidies will be available to those with low-incomes or very high drug costs. Important questions exist about the impact of Part D on medication use. With NIA funding, we developed new measures to track behaviors collectively known as cost-related underuse of medicines (CRUM). In 2004, one set of CRUM measures was incorporated into the Medicare Current Beneficiary Survey (MCBS; N approximately 15,000 per year), the principal national survey for designing and evaluating health policies for Medicare enrollees. The principal goal of this investigation is to measure changes in drug coverage, use, spending, and CRUM among elderly Medicare beneficiaries before and after implementation of the MMA (2005-2007), with a particular focus on poor and chronically ill beneficiaries who will qualify for substantially subsidized coverage and near-poor beneficiaries who will not. Our study will use 6 years of MCBS panel data prior to the MMA and 2 years afterwards (2000-2007). We will stratify the sample into three mutually-exclusive income groups which, when we account for pre-MMA dual eligibility status, have different potential susceptibility to MMA benefits. We will also focus on hypertension and diabetes, two chronic medical conditions that are highly prevalent, identifiable in this dataset, and for which effective medicines are available and clinically beneficial. The specific aims will be: (1) describe the prevalence, trend, and year-to-year individual changes in insurance coverage for prescription drugs, generosity of coverage, total drug utilization, use of highly effective drugs for diabetes and hypertension, and drug expenditures during the six-year period prior to the MMA (2000 to 2005); (2) using new measures of CRUM, describe pre-MMA (2004-2005) patterns of CRUM by income and chronic illness group, including associations between changes in the prevalence and generosity of coverage and changes in CRUM; and (3) in cohort- and individual specific analyses, evaluate the impact of the MMA (2005-2007) and associated changes in coverage generosity on total drug utilization and expenditures, CRUM and use of highly effective medicines among patients with diabetes and hypertension. We hypothesize that low income enrollees without Medicaid coverage who enroll in Part D will have increased access to effective drugs and reduced CRUM. The MMA represents an unprecedented re-organization of prescription drug coverage for American seniors. The proposed longitudinal research will measure the impact of the MMA on cost-related barriers in access to appropriate drug therapy among poor, near-poor, and chronically ill seniors.

描述（由申请人提供）：由于保险范围不足，数以百万计的美国人缺乏经济获取基本药物的机会。 2003年的《医疗保险现代化法》（MMA）将允许Medicare受益人从2006年1月开始购买处方药福利（D部分）。低收入或非常高的药物成本的人将获得额外的补贴。关于D部分对药物使用的影响的重要问题。通过NIA资金，我们制定了新的措施，以跟踪行为，共同称为与成本有关的药品（CRUM）。 2004年，一组CRUM措施被纳入了Medicare当前的受益人调查中（MCBS；每年约15,000个），这是针对Medicare参与者设计和评估健康政策的主要国家调查。这项调查的主要目的是衡量在实施MMA之前和之后，老年医疗保险受益人在MMA（2005-2007）之前和之后的药物覆盖率，使用，支出和cr虫的变化，并特别关注将有资格获得实质性补贴的覆盖范围和近乎接近的受益人的贫困和长期不适的受益人。我们的研究将在MMA之前使用6年的MCB面板数据，然后使用2年（2000-2007）。我们将将样本分为三个相互排放的收入群体，当我们考虑MMA二元资格状态时，对MMA福利具有不同的潜在敏感性。我们还将专注于高血压和糖尿病，这是两个高度普遍，在该数据集中可识别的慢性病，​​并且有效的药物可用且在临床上有益。具体目的是：（1）描述处方药的保险覆盖范围的普遍性，趋势和年度个人变化，覆盖范围的慷慨，全面药物利用，用于糖尿病和高血压的高效药物以及在MMA（2000年至2005年2000年至2005年）之前六年（2000年）的糖尿病和药物支出； （2）使用新的CRUM措施，描述MMA（2004-2005）按收入和慢性疾病组的CRUM模式，包括覆盖率的发生率和慷慨的变化与CRUM变化之间的关联； （3）在队列和个人特定分析中，评估MMA（2005-2007）的影响以及覆盖范围慷慨对总药物利用和支出，CRUM，CRUM和使用高效药物的影响。我们假设没有医疗补助覆盖的低收入参与者将增加获得有效药物并减少CRUM的机会。 MMA代表了对美国老年人处方药覆盖的前所未有的重组。拟议的纵向研究将衡量MMA对与成本相关的障碍的影响，以获取贫困，近乎贫困和长期病人的贫困药物治疗。