Impact of Prescription Caps on Health Outcomes in People Infected with HIV

项目摘要 现代抗逆转录病毒疗法（ART）的可用性已将感染变为可管理的慢性感染。 艾滋病毒感染者（PLWH）可以获得并坚持治疗。遵守 治疗艾滋病毒或主要医疗和心理健康状况的药物经常是次优的， 有处方保险的人那些患有多种慢性疾病的人面临着复杂的不利因素， 当他们不服用必要的药物时，后果。处方药成本控制措施可能 破坏长期坚持与不良健康后果的影响，虽然身体的 文献相当有限，尤其是在艾滋病毒的背景下。尽管有这样的理解， 管理人员，特别是各州的医疗补助计划，继续通过各种方式实施限制， 使用管理策略，如处方上限政策，限制药物数量 每月覆盖。在我们最近对ART、肾素血管紧张素拮抗剂和 二甲双胍在HIV+与HIV- Medicaid登记者中的应用，我们注意到在限制性 处方药瓶盖我们的长期研究目标是确保有效的药物利用管理 平衡预算优先事项与人口生活质量和数量的政策。的目的 应用程序是评估医疗补助处方上限政策如何影响艾滋病毒感染者的健康， 公共支出。我们建议研究国家的注册，处方，医院和医疗索赔数据 多年来，利用药物上限的采用，更改和编辑。特别是， 我们将研究医疗补助和医疗保险登记的艾滋病毒，以说明如何以国家为基础的政策有助于 在这一特别脆弱的群体中取得的成果。这些自然实验将为以下方面提供重要见解 限制性处方政策对患者健康结果和公共预算的影响。中央 一种假设是，处方上限将导致艾滋病毒感染者和非艾滋病毒慢性感染者的发病率更高， 疾病并发症，导致额外的费用。这一假设的基本原理是， 经常有并发症，可能需要同时使用几种处方， 他们每月收到的数字可能会损害他们的健康。我们已经进行了大量的投资， 并建立了广泛的经验，医疗补助索赔数据从14个高艾滋病毒流行率的国家（2001年- 2012年）。通过增加三年的医疗补助申请（2013-2015）和纳入医疗保险， 2006-2015年，全国约30万艾滋病毒感染者的A、B和D部分索赔，我们将 有一个全面的基础设施，我们可以从中描述处方上限对ART的影响 依从性，评价处方上限政策对主要共病药物依从性的影响 条件（即，糖尿病，心血管疾病，严重精神疾病），并估计潜在的 抗逆转录病毒疗法和慢性病药物治疗依从性对健康和经济的影响是可以避免的。

PROJECT SUMMARY The availability of contemporary antiretroviral therapy (ART) has changed infection into a manageable chronic disease for people living with HIV (PLWH) who have access to and are adherent with treatment. Adherence to medications for either HIV or major medical and mental health conditions is frequently suboptimal even for those with prescription coverage. Those with multiple, chronic diseases face compounded adverse consequences when they fail to take necessary medications. Prescription drug cost containment efforts may undermine long-term adherence with implications for adverse health consequences, though the body of literature is fairly limited and dated particularly in the context of HIV. Despite this understanding, plan managers, particularly states' Medicaid programs, continue to implement restrictions through a variety of utilization management strategies such as prescription cap policies, limiting the number of medications covered per month. In our recent analyses of persistence rates for ART, renin angiotensin antagonists, and metformin in HIV+ versus HIV- Medicaid enrollees, we noted lower persistence in states with restrictive prescription caps. Our long-term research goal is to ensure effective medication utilization management policies which balance budget priorities with population quality and quantity of life. The objective of this application is to evaluate the how Medicaid prescription cap policies impact the health of persons with HIV and public expenditures. We propose to study national enrollment, prescription, hospital, and medical claims data across multiple years, exploiting the adoption of, changes to, and redaction of medication caps. In particular, we will study Medicaid and Medicare enrollees with HIV to illustrate how state-based policies contribute to outcomes in this particularly vulnerable population. These natural experiments will offer significant insights into the impact of restrictive prescription policies on patients' health outcomes and public budgets. The central hypothesis is that prescription caps will lead patients with HIV to greater rates of HIV and non-HIV chronic disease complications, leading to additional costs. The rationale for this hypothesis is that people with HIV frequently have co-occurring conditions likely to require several prescriptions simultaneously and capping the number they receive each month may undermine their health. We have already made a large investment in and established extensive experience with Medicaid claims data from 14 high HIV prevalence states (2001- 2012). Through the addition of three more years of Medicaid claims (2013-2015) and the inclusion of Medicare Parts A, B and D claims from ~300,000 HIV infected beneficiaries across the country from 2006-2015, we will have a comprehensive infrastructure from which we can describe the impact of prescription caps on ART adherence, evaluate the impact of prescription cap policies on adherence to medications for major comorbid conditions (i.e., diabetes, cardiovascular disease, serious mental illness), and estimate the potentially avoidable health and economic effects of ART and chronic disease medication adherence.