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

项目总结 现代抗逆转录病毒疗法(Art)的出现已将感染转变为一种可控制的慢性 艾滋病毒携带者(PLWH)可以获得并坚持接受治疗的人患上这种疾病。坚持 治疗艾滋病毒或重大医疗和精神健康问题的药物往往不太理想，即使是对 那些有处方保险的人。那些患有多种慢性病的人面临着复杂的不良反应 如果他们没有服用必要的药物，就会产生后果。处方药成本控制努力可能 破坏长期坚持，影响不利的健康后果，尽管身体 特别是在艾滋病毒的背景下，文献相当有限和过时。尽管有这样的理解，计划 管理者，特别是各州的医疗补助计划，继续通过各种不同的 利用管理策略，如处方上限政策、限制药物数量 按月投保。在我们最近对ART、肾素血管紧张素拮抗剂和 在HIV与HIV-Medicaid参与者中，我们注意到具有限制性的州的持久性较低 处方帽。我们的长期研究目标是确保有效的用药管理 平衡预算优先事项与人口生活质量和数量的政策。这样做的目的是 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携带者和 公共支出。我们建议研究国家登记、处方、医院和医疗索赔数据 多年来，利用对药物上限的采用、更改和编辑。特别是， 我们将研究感染艾滋病毒的联邦医疗补助和医疗保险参与者，以说明基于州的政策如何有助于 在这一特别脆弱的人群中取得的成果。这些自然实验将提供对 限制性处方政策对患者健康结果和公共预算的影响。中环 假设是，处方上限将导致艾滋病毒患者更高的艾滋病毒和非艾滋病毒慢性 疾病并发症，导致额外的成本。这一假设的基本原理是，艾滋病毒携带者 经常同时发生的情况可能需要同时开几个处方，并限制 他们每月收到的数字可能会损害他们的健康。我们已经在以下方面进行了大笔投资 并在14个艾滋病毒高发州的医疗补助申领数据方面建立了丰富的经验(2001- 2012年)。通过增加三年以上的医疗补助报销(2013-2015)和纳入医疗保险 A、B和D部分从2006-2015年间全国约300,000名艾滋病毒感染者那里获得索赔，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，评估处方上限政策对主要并存患者坚持用药的影响 疾病(即糖尿病、心血管疾病、严重精神疾病)，并估计潜在的 抗逆转录病毒治疗和慢性病药物治疗可避免的健康和经济影响。

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.