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

由于保险不足，数百万美国老年人无法经济地获得基本药物 覆盖范围。2003年《联邦医疗保险现代化法案》(MMA)将允许联邦医疗保险受益人购买 处方药福利(D部分)，从2006年1月开始。额外的补贴将提供给那些 低收入或非常高的药费。关于D部分的影响存在重要问题 药物使用。在NIA的资助下，我们开发了新的措施来跟踪统称为 与成本相关的药品使用不足(CRUM)。2004年，一套CRUM措施被纳入 医疗保险现行受益人调查(MCBS；每年N~15,000人)，主要的全国性调查，以设计 以及评估医疗保险参保人的健康政策。 这项调查的主要目标是衡量药物覆盖率、使用、支出和CRUM的变化 在实施MMA之前和之后的老年医疗保险受益人中(2005-2007年)， 特别关注贫困和慢性病受益人，他们将有资格获得大量补贴的保险 以及不会这么做的近乎贫困的受益者。我们的研究将使用MMA之前6年的MCBS面板数据 两年后(2000-2007年)。我们将把样本分成三个相互排斥的收入组 当我们考虑到MMA前的双重资格状态时，他们有不同的潜在MMA易感性 福利。我们还将重点关注高血压和糖尿病，这两种慢性疾病的发病率很高 流行的，在此数据集中可识别的，可获得有效药物并在临床上有益的。 具体目标将是：(1)描述以下方面的流行率、趋势和每年的个人变化 处方药保险覆盖范围、覆盖范围的慷慨程度、总药物利用、高使用率 治疗糖尿病和高血压的有效药物，以及前六年期间的药品支出 MMA(2000-2005)；(2)使用新的CRUM度量，描述了前MMA(2004-2005)CRUM的模式 按收入和慢性病分组，包括患病率变化和慢性病之间的关系 覆盖范围和CRUM变化的慷慨程度；以及(3)在队列和个体具体分析中，评估 MMA(2005-2007)及相关的覆盖面慷慨变化对总药物利用的影响 和费用、CRUM和糖尿病患者中高效药物的使用 高血压。我们假设，没有医疗补助覆盖范围的低收入投保人将参加D部分 增加了获得有效药物的机会，减少了CRUM。 MMA代表着美国处方药覆盖范围的前所未有的重组 高年级学生。拟议的纵向研究将衡量MMA对#年成本相关壁垒的影响 在贫困、近乎贫困和患有慢性病的老年人中获得适当的药物治疗。

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~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.