Prescription drug spending for beneficiaries in the last Medicare plus Choice year of life
Prescription drug spending for beneficiaries in the last Medicare plus Choice year of life
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DOI：
10.1089/jpm.2006.9.884
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发表时间：
2006-08-01
影响因子：
2.8
通讯作者：
Finch, Mike
中科院分区：
文献类型：
--
作者：
Fahlman, Cheryl;Lynn, Joanne;Finch, Mike
背景：2006年，医疗保险实施了处方福利计划。因此，了解生命末期的药物费用可能有助于指导临床医生为慢性病患者导航Medicare Part D承保范围。目的：我们检查了Medicare+Choice（M+C）受益人在生命最后一年（LYOL）的疾病和人口统计数据的药物支出。研究设计：对1998年1月至2000年12月期间收集的M+C死亡者的药物索赔和登记数据进行回顾性审查，并辅以Medicare分母文件和1990年人口普查数据。四千六百二受益人在一个大型的国家管理的医疗organization.Measures：我们分析了处方药支出和社会人口描述符，保险特点，死因causeofdeath.Results之间的关系：处方填充的平均年数为36.9;管理的医疗组织（MCO）支付539美元，受益人支付627美元。较高的支出与女性性别、较高的合并症数量以及受益人是否获得保险作为基于雇主的退休人员福利显著相关。少数族裔受益人的处方减少了26%。在家庭年收入中位数低于20，000美元和家庭年收入中位数高于40，000美元的人群中，随着家庭年收入中位数的增加，处方数量增加20%，平均自付费用增加25%。在LYOL中，慢性阻塞性肺疾病和糖尿病的平均处方数量和总费用最高。死于中风或其他不可分类的条件下的平均处方数和平均总expenditures.Conclusion：在LYOL的药物支出是高度依赖于选定的社会人口，保险的特点，和疾病状态。
Background: In 2006, Medicare implemented its prescription benefit plan. Therefore, insights into medication costs at the end of life may help guide clinicians to navigate Medicare Part D coverage for chronically ill individuals.Objectives: We examined drug spending by disease and demographics for Medicare+Choice (M+C) beneficiaries in the last year of life (LYOL).Research design: Retrospective review of M+C decedents' drug claims and enrollment data collected between January 1998 and December 2000, supplemented by the Medicare denominator file and 1990 Census data.Subjects: Four thousand six hundred two beneficiaries in a large national managed care organization.Measures: We analyzed the relationship between prescription drug expenditures and sociodemographic descriptors, insurance characteristics, and cause of death.Results: The mean annual number of prescriptions filled was 36.9; the managed care organization (MCO) paid $539 and beneficiaries paid $627. Higher expenditures were significantly correlated with female gender, higher number of comorbidities, and whether beneficiaries obtained the insurance as an employer-based retiree benefit. Minority beneficiaries had 26% fewer prescriptions. Increasing levels of annual median household income corresponded with a 20% increase in the number of prescriptions and a 25% increase in mean out-of-pocket expenses, between those with a median household income of less than $20,000 and those with $40,000 or greater.In the LYOL, chronic obstructive pulmonary disease and diabetes had the highest average number of prescriptions and total expenditures. Individuals dying from strokes or other unclassifiable conditions had the lowest average number of prescriptions and average total expenditures.Conclusion: Medication expenditures in the LYOL were highly dependent upon selected sociodemographic, insurance characteristics, and disease states.