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）：由于保险覆盖范围不足，数百万美国老年人缺乏获得基本药物的经济途径。 2003 年医疗保险现代化法案 (MMA) 将允许医疗保险受益人从 2006 年 1 月开始购买处方药福利（D 部分）。低收入或药品费用非常高的人还将获得额外补贴。关于 D 部分对药物使用的影响存在重要问题。在 NIA 的资助下，我们制定了新的措施来追踪统称为与成本相关的药物使用不足 (CRUM) 的行为。 2004 年，一套 CRUM 措施被纳入医疗保险当前受益人调查（MCBS；每年大约 15,000 人），这是为医疗保险参保者设计和评估健康政策的主要国家调查。本次调查的主要目标是衡量 MMA 实施前后（2005-2007 年）老年医疗保险受益人的药物覆盖范围、使用、支出和 CRUM 的变化，特别关注有资格获得大幅补贴覆盖范围的贫困和慢性病受益人以及没有资格获得大幅补贴覆盖范围的近贫困受益人。我们的研究将使用 MMA 之前 6 年和之后 2 年（2000-2007 年）的 MCBS 面板数据。我们将样本分层为三个互斥的收入群体，当我们考虑 MMA 之前的双重资格状态时，这些群体对 MMA 福利具有不同的潜在敏感性。我们还将重点关注高血压和糖尿病，这两种慢性疾病非常普遍，可以在该数据集中识别出来，并且可以使用有效的药物并且在临床上有益。具体目标是： (1) 描述 MMA 之前六年（2000 年至 2005 年）期间处方药保险覆盖范围、覆盖范围、药物使用总量、高效治疗糖尿病和高血压药物的使用以及药物支出的患病率、趋势和逐年个人变化； (2) 使用新的 CRUM 衡量标准，按收入和慢性疾病组描述 MMA 之前（2004-2005 年）的 CRUM 模式，包括覆盖率和慷慨程度的变化与 CRUM 变化之间的关联； (3) 在队列和个人具体分析中，评估 MMA（2005-2007 年）和覆盖慷慨度的相关变化对糖尿病和高血压患者的药物总利用和支出、CRUM 和高效药物使用的影响。我们假设没有医疗补助覆盖的低收入参保者参加 D 部分将有更多机会获得有效药物并减少 CRUM。 MMA 代表了美国老年人处方药保险范围的前所未有的重组。拟议的纵向研究将衡量 MMA 对贫困、接近贫困和慢性病老年人获得适当药物治疗的成本相关障碍的影响。