Comparing Methods to Pay for Psychotropic Medications for Medicare Beneficiaries

比较医疗保险受益人支付精神药物的方法

• 批准号: 7936989
• 负责人: Yuting Zhang
• 金额: $ 41.28万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7936989
• 关键词: Adherence; Adverse effects; Affect; Bipolar Disorder; Cardiovascular system; Caregivers; Caring; Characteristics; Chronic; Clinical; Comorbidity; Data; Diabetes Mellitus; Drug Controls; Drug Prescriptions; Drug usage; Economics; Expenditure; Generic Drugs; Goals; Health; Heart Diseases; Hospitalization; Insurance; Knowledge; Lead; Literature; Major Depressive Disorder; Medical; Medicare; Mental Depression; Mental Health; Mental disorders; Methods; Morbidity - disease rate; Names; Outcome; Patients; Pattern; Pharmaceutical Preparations; Pharmacy facility; Policy Maker; Proton Pump Inhibitors; Psychotropic Drugs; Regimen; Relapse; Reporting; Research; Schizophrenia; Symptoms; Variant; Vulnerable Populations; Work; base; beneficiary; cost; cost effective; design; diabetic; experience; meetings; models and simulation; mortality; non-drug; physical conditioning

DESCRIPTION (provided by applicant): A controversial component of the Medicare Prescription Drug Benefit (Part D) enacted in 2006 is the "doughnut hole", a gap in coverage for pharmacy expenditures between $2,250 and $5,100. We recently reported that one in four seniors entered the doughnut hole in 2006 and reduced their number of prescribed medications by 14% per month after entering it.1 Cost-related medication non-adherence can worsen health outcomes, lead to higher rates of hospitalization, and increase overall medical care spending.2, 3 The coverage gap may be particularly detrimental to Medicare beneficiaries with chronic mental disorders such as major depression, bipolar disorder, and schizophrenia, but we know almost nothing about how they respond to the coverage gap. We will use merged national Medicare pharmacy and medical data to evaluate changes in medication use and clinical outcomes before and after entering the doughnut hole, among beneficiaries with three mental disorders. We then use the estimated effect to assess the most cost-effective approaches to covering psychotropic medications in the doughnut hole. We will compare approaches that involve: a) covering generic psychotropic drugs, b) covering all psychotropic drugs for a certain subpopulation, and c) reducing the size of the doughnut hole. Findings from our study will provide critical information for policy makers to redesign Part D benefits or value-based insurance design in general. Equipped with this information, in addition, clinicians and care givers can anticipate the adverse effects of the doughnut hole and proactively work together with patients to develop alternative regimens. Major depression, bipolar disorder and schizophrenia are costly and disabling illnesses, which affect over 15% of Medicare beneficiaries and cost $165 billion annually in the US. Over half of Medicare beneficiaries with these mental disorders spent more than $2,250 on pharmacy expenditures in 2006, and many were fully exposed to the coverage gap under current Medicare Part D benefit design. We propose to assess the most cost- effective, potentially cost-saving, methods to pay for psychotropic medications for these beneficiaries entering the coverage gap.

描述（由申请人提供）：2006年颁布的医疗保险处方药福利（D部分）的一个有争议的组成部分是“甜甜圈洞”，即2,250美元至5100美元之间的药房支出缺口。我们最近报道说，2006年，四分之一的老年人进入甜甜圈洞，进入甜甜圈洞后，他们每月的处方药数量减少了14%。1与成本相关的药物不依从性会使健康状况恶化，导致住院率上升，并增加整体医疗保健支出。3覆盖范围的差距可能对患有慢性精神障碍的医疗保险受益人特别不利，如重度抑郁症，双相情感障碍和精神分裂症，但我们对他们如何应对覆盖率缺口几乎一无所知。我们将使用合并的国家医疗保险药房和医疗数据，以评估药物使用和临床结果的变化之前和之后进入甜甜圈洞，受益人与三种精神疾病。然后，我们使用估计的效果来评估最具成本效益的方法，以涵盖甜甜圈洞中的精神药物。我们将比较涉及以下方面的方法：a）涵盖非专利精神药物，B）涵盖特定亚群的所有精神药物，以及c）缩小甜甜圈洞的大小。我们的研究结果将为政策制定者重新设计D部分福利或基于价值的保险设计提供关键信息。此外，有了这些信息，临床医生和护理人员可以预测甜甜圈洞的不良影响，并积极与患者合作开发替代方案。重度抑郁症、双相情感障碍和精神分裂症是代价高昂且致残的疾病，影响了超过15%的医疗保险受益人，在美国每年花费1650亿美元。2006年，超过一半患有这些精神障碍的医疗保险受益人在药房支出上花费了超过2，250美元，其中许多人在当前的医疗保险D部分福利设计下完全暴露在覆盖范围缺口中。我们建议评估最具成本效益，潜在的成本节约，方法来支付精神药物的这些受益人进入覆盖范围的差距。