Impact of Medicare Drug Benefit on Use and Cost-related Underuse of Medicines

医疗保险药物福利对药物使用和与成本相关的药物使用不足的影响

• 批准号: 7624602
• 负责人: STEPHEN B SOUMERAI
• 金额: $ 64.11万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-15 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7624602
• 关键词: Accounting; Address; Affect; American; Antihypertensive Agents; Behavior; Cardiac; Chronic; Chronic Disease; Chronically Ill; Communities; Cost Measures; Data; Data Set; Diabetes Mellitus; Dose; Drug Costs; Drug Prescriptions; Drug Utilization; Economics; Elderly; Eligibility Determination; Enrollment; Event; Expenditure; Face; Funding; Goals; Grant; Health Care Costs; Health Policy; Health Status; Hypertension; Hypoglycemic Agents; Income; Individual; Inpatients; Insurance Coverage; Investigation; Lead; Letters; Lipids; Low income; Measures; Medicaid; Medical; Medicare; Medicare/Medicaid; Medicine; Minor; Modernization; Morbidity - disease rate; Myocardial Infarction; National Institute on Aging; Natural experiment; Outpatients; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Population; Poverty; Predisposition; Preparation; Prevalence; Process; Qualifying; Recording of previous events; Regression Analysis; Research; Research Personnel; Resort; Risk; Sampling; Services; Surveys; Vulnerable Populations; base; beneficiary; cohort; cost; design; experience; follow-up; mortality; programs; trend; uptake

Millions of elderly Americans lack economic access to essential medications due to insufficient insurance coverage. The Medicare Modernization Act of 2003 (MMA) will allow Medicare beneficiaries to purchase a prescription drug benefit (Part D), beginning in January 2006. Additional subsidies will be available to those with low-incomes or very high drug costs. Important questions exist about the impact of Part D on medication use. With NIA funding, we developed new measures to track behaviors collectively known as cost-related underuse of medicines (CRUM). In 2004, one set of CRUM measures was incorporated into the Medicare Current Beneficiary Survey (MCBS; N~15,000 per year), the principal national survey for designing and evaluating health policies for Medicare enrollees. The principal goal of this investigation is to measure changes in drug coverage, use, spending, and CRUM among elderly Medicare beneficiaries before and after implementation of the MMA (2005-2007), with a particular focus on poor and chronically ill beneficiaries who will qualify for substantially subsidized coverage and near-poor beneficiaries who will not. Our study will use 6 years of MCBS panel data prior to the MMA and 2 years afterwards (2000-2007). We will stratify the sample into three mutually-exclusive income groups which, when we account for pre-MMA dual eligibility status, have different potential susceptibility to MMA benefits. We will also focus on hypertension and diabetes, two chronic medical conditions that are highly prevalent, identifiable in this dataset, and for which effective medicines are available and clinically beneficial. The specific aims will be: (1) describe the prevalence, trend, and year-to-year individual changes in insurance coverage for prescription drugs, generosity of coverage, total drug utilization, use of highly effective drugs for diabetes and hypertension, and drug expenditures during the six-year period prior to the MMA (2000 to 2005); (2) using new measures of CRUM, describe pre-MMA (2004-2005) patterns of CRUM by income and chronic illness group, including associations between changes in the prevalence and generosity of coverage and changes in CRUM; and (3) in cohort- and individual specific analyses, evaluate the impact of the MMA (2005-2007) and associated changes in coverage generosity on total drug utilization and expenditures, CRUM and use of highly effective medicines among patients with diabetes and hypertension. We hypothesize that low income enrollees without Medicaid coverage who enroll in Part D will have increased access to effective drugs and reduced CRUM. The MMA represents an unprecedented re-organization of prescription drug coverage for American seniors. The proposed longitudinal research will measure the impact of the MMA on cost-related barriers in access to appropriate drug therapy among poor, near-poor, and chronically ill seniors.

由于保险不足，成千上万的美国人缺乏经济获得基本药物的机会 覆盖范围。 2003年《医疗保险现代化法》（MMA）将允许医疗保险受益人购买 处方药益处（D部分），从2006年1月开始。 低收入或很高的药物成本。关于D部分对的影响的重要问题 用药使用。通过NIA资助，我们制定了新的措施来跟踪行为统称为 与成本有关的药品（CRUM）的不足。 2004年，将一组CRUM措施纳入了 Medicare当前的受益人调查（MCBS；每年N〜15,000），全国设计的主要调查 并评估医疗保险参与者的健康政策。 这项调查的主要目的是衡量药物覆盖，使用，支出和crum的变化 在实施MMA之前和之后的老年医疗保险受益人（2005-2007）中， 特别关注贫困和长期病人的受益人，他们有资格获得基本补贴的覆盖范围 和近乎贫穷的受益人。我们的研究将在MMA之前使用6年的MCB面板数据 和两年后（2000-2007）。我们将将样本分为三个共同的收入组 当我们考虑MMA前双重资格状态时，对MMA具有不同的潜在敏感性 好处。我们还将专注于高血压和糖尿病，两种慢性病 在此数据集中普遍，可识别，并且可以为此提供有效的药物且在临床上有益。 具体目的是：（1）描述在 处方药的保险范围，慷慨的覆盖范围，总药物利用率，高度使用 在六年之前 MMA（2000年至2005年）； （2）使用新的CRUM措施，描述Pre-MMA（2004-2005）CRUM的模式 按收入和慢性疾病组，包括患病率变化与 覆盖范围和CRUM变化的慷慨； （3）在队列和各个特定分析中，评估 MMA（2005-2007）的影响以及覆盖范围的相关变化对总药物利用率 以及在糖尿病患者和 高血压。我们假设低收入的参与者没有医疗补助覆盖范围 增加获得有效药物并减少CRUM的机会。 MMA代表了美国美国处方药覆盖范围的空前重组 老年人。拟议的纵向研究将衡量MMA对与成本相关的障碍的影响 在贫困，近po和长期患病的老年人中获得适当的药物治疗。