Cox E R, Jernigan C, Coons S J, Draugalis J L
Express Scripts, Inc, Maryland Heights, Missouri 63043, USA.
Med Care. 2001 Mar;39(3):296-301. doi: 10.1097/00005650-200103000-00009.
Having annual dollar limits in prescription coverage is a type of benefit design unique to Medicare beneficiaries. This type of coverage is found predominantly within private Medigap policies and Medicare+Choice plans offering prescription coverage.
The purpose of this study was to determine the impact of capped prescription benefits on efforts to reduce out-of-pocket prescription expenses by beneficiaries at risk for reaching their cap.
This design was quasi-experimental, with data obtained from self-administered questionnaires mailed to 600 Medicare HMO risk enrollees with capped prescription benefits.
Data were collected on 378 Medicare enrollees for a 63% response rate. Approximately half of all respondents participated in > or =1 strategy to reduce their out-of-pocket prescription expenses. Participation in selected strategies included obtaining samples from physicians (39.2%), taking less than prescribed amounts (23.6%), and discontinuing prescribed medications (16.3%). Additionally, 15% of respondents indicated going without necessities, and 12% indicated borrowing money to pay for their prescriptions. Those who reached their prescription cap were more likely to participant in any one behavior (odds ratio [OR], 2.18), more likely to take less medication than prescribed (OR, 2.83), more likely to discontinue a medication (OR, 3.36), and more likely to obtain samples from their physician (OR, 2.02) compared with those who had not reached their prescription cap.
Beneficiaries at risk for reaching their prescription cap are taking steps to reduce their out-of-pocket prescription costs. Although some behaviors would be considered prudent, other behaviors may be placing beneficiaries at risk for drug-related morbidity and mortality.
在处方药保险中设置年度金额限制是医疗保险受益人特有的一种福利设计类型。这种保险类型主要存在于提供处方药保险的私人医疗补助政策和“医疗保险+选择”计划中。
本研究的目的是确定有上限的处方药福利对有达到上限风险的受益人减少自付处方药费用努力的影响。
本设计为准实验性设计，数据来自邮寄给600名有上限处方药福利的医疗保险健康维护组织风险参保人的自填问卷。
收集了378名医疗保险参保人的数据，回复率为63%。所有受访者中约有一半采取了≥1种策略来减少自付处方药费用。所采取的特定策略包括从医生处获取样品（39.2%）、服用少于规定剂量的药物（23.6%）以及停止服用规定药物（16.3%）。此外，15%的受访者表示放弃生活必需品，12%的受访者表示借钱支付处方药费用。与未达到处方药上限的人相比，达到处方药上限的人更有可能采取任何一种行为（优势比[OR]，2.18），更有可能服用少于规定剂量的药物（OR，2.83），更有可能停止服用某种药物（OR，3.36），也更有可能从医生处获取样品（OR，2.02）。
有达到处方药上限风险的受益人正在采取措施减少自付处方药费用。虽然有些行为可能被认为是谨慎的，但其他行为可能会使受益人面临与药物相关的发病和死亡风险。
