Benefit Generosity, Specialty Drug Use, and Other Health Service Use in Medicare

说明书(申请人提供)：特殊药物通常是指用于治疗严重和复杂疾病的高成本生物药物。在许多情况下，它们可以为病情几乎没有替代治疗的患者提供延长生命或显著的生活质量好处。然而，它们的价格远远高于传统药品，而且它们快速上涨的成本是一个重要的担忧。随着新药的问世，对特殊药物的需求预计将大幅增加。面对这一令人震惊的趋势，支付者和政策研究人员呼吁紧急关注制定有效管理特殊药物使用的战略，认识到特殊药物将成为未来医疗成本的主要驱动因素。效益设计是处方药利用管理的常用方法。先前的文献表明，患者分担费用会减少处方药的使用。然而，目前尚不清楚类似的方法在管理特殊药物使用方面是否有效，因为特殊药物没有仿制药替代品或其他治疗等价物。为特殊药物设计福利将涉及艰难的选择，因为在平衡患者获得机会和努力控制医疗成本之间存在挑战。为了应对这一挑战，了解患者使用特殊药物对慷慨的好处有何反应是至关重要的。还需要关于特殊药物福利的价值或有效性的信息。然而，关于这些问题的证据很少。我们建议研究福利慷慨对老年医疗保险受益人使用特殊药物和其他医疗保健服务的影响。使用我们的研究团队可以访问的几个文件中的八年联邦医疗保险数据，我们将检查一套全面的药物和其他医疗服务使用措施，包括(1)启动特殊药物，(2)特殊药物支出，(3)住院治疗，(4)门诊设施使用(例如，门诊手术)，(5)医生就诊，(6)急性后护理使用，(7)临终关怀服务使用，(8)A/B部分总成本，以及(9)B部分承保药品支出。我们建议的研究利用D部分利益的外生变化来确定费用分担对特殊药物和其他医疗保健使用的影响。这是一个独特的机会，可以解决与特殊药物使用相关的问题，而不会遇到与特殊药物好处相关的可能的内源性问题。我们还将评估D部分计划在特殊药物成本分担方面的差异如何影响特殊药物的使用。在这种方法中，我们将使用工具变量(IV)方法来解决特殊药物益处的潜在内生性。通过研究药品福利设计、特殊药物使用和其他卫生服务利用之间的关系，我们的研究将提供重要的信息，有助于指导政策讨论和探索特殊药物的福利设计。

DESCRIPTION (provided by applicant): Specialty drugs typically refer to high-cost biologic drugs used to treat serious and complex conditions. In many cases, they can offer life-extending or significant quality-of-life benefits to patients with conditions that have few alternative treatments. However, their prices are substantially higher than those of traditional pharmaceuticals, and their rapidly-rising costs are an important concern. Demand for specialty drugs is expected to increase dramatically as new drugs become available. Facing this alarming trend, payers and policy researchers are calling for urgent attention to develop strategies to effectively manage specialty drug use, recognizing that specialty drugs will be a major driver of future health care costs. Benefit design is commonly used to manage prescription drug utilization. Prior literature suggests that patient cost-sharing reduces prescription drug utilizaton. However, it is not clear whether similar approaches would be effective in managing specialty drug use because specialty drugs do not have generic substitutes or other therapeutic equivalents. Designing benefits for specialty drugs will involve tough choices because of the challenge of balancing patients' access with efforts to control health care costs. To address this challenge, it is essential to know how patients' use of specialty drugs responds to benefit generosity. Information on the value or effectiveness of specialty drug benefits is also needed. Yet, evidence on these issues is sparse. We propose to examine the impact of benefit generosity on the use of specialty drugs and other health care services among elderly Medicare beneficiaries. Using eight years of Medicare data from several files to which our research team has access, we will examine a comprehensive set of drug and other health service use measures, including (1) initiation of specialty drugs, (2) spending on specialty drugs, (3) hospita admissions, (4) outpatient facility use (e.g., outpatient surgery), (5) physician visits, (6) post-acute care use, (7) hospice service use, (8) total Part A/B costs, and (9) spending on Part B- covered drugs. Our proposed study leverages an exogenous change in the Part D benefit to identify the effect of cost-sharing on specialty drug and other health care use. This is a unique opportunity to address issues related to specialty drug use without encountering a possible endogeneity problem associated with specialty drug benefits. We will also assess how differences in specialty drug cost- sharing imposed by Part D plans affect specialty drug use. In this approach, we will use an instrumental variables (IV) method to address the potential endogeneity of specialty drug benefits. By examining the relations among drug benefit design, specialty drug use, and other health service utilization, our study will provide important information that could help guide policy discussions and explore benefit designs for specialty drugs.