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

描述（由申请人提供）：由于保险覆盖面不足，数百万美国老年人无法获得基本药物。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）。低收入或药费非常高的人将获得额外补贴。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跟踪统称为与费用有关的药物使用不足（CRUM）的行为。2004年，一套CRUM措施被纳入医疗保险现行受益人调查（MCBS；每年约15,000人），这是设计和评估医疗保险参保人健康政策的主要全国调查。本调查的主要目的是衡量MMA实施前后（2005-2007年）老年医疗保险受益人在药品覆盖、使用、支出和CRUM方面的变化，特别关注贫困和慢性病受益人，他们有资格获得大量补贴，而接近贫困的受益人则没有资格获得补贴。我们的研究将使用MMA前6年和MMA后2年（2000-2007）的MCBS面板数据。我们将样本分为三个相互排斥的收入群体，当我们考虑到MMA前的双重资格状态时，它们对MMA福利的潜在敏感性不同。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，在这个数据集中可以识别出来，并且有有效的药物可供使用并且临床有益。具体目标将是：(1)描述在MMA之前的6年期间（2000年至2005年），处方药保险覆盖范围的流行程度、趋势和每年的个人变化、覆盖范围的慷慨程度、药物总利用率、糖尿病和高血压高效药物的使用以及药物支出；(2)利用新的CRUM测量方法，描述了mma前（2004-2005）按收入和慢性病群体划分的CRUM模式，包括患病率和覆盖范围的变化与CRUM变化之间的关系；(3)在队列和个体具体分析中，评估MMA（2005-2007）和相关的覆盖范围变化对糖尿病和高血压患者总药物使用和支出、CRUM和高效药物使用的影响。我们假设，没有医疗补助的低收入参保者参加D部分将增加获得有效药物的机会，并减少CRUM。MMA代表了美国老年人处方药覆盖范围的前所未有的重组。拟议的纵向研究将衡量MMA对穷人、近穷人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。

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.