加利福尼亚州药房对医疗保险受益人的处方药折扣计划的遵守情况。

Lewis Joy H, Schonlau Matthias, Muñoz Jorge A, Asch Steven M, Rosen Mayde R, Yang Hannah, Escarce José J

RAND Health, Santa Monica, Calif 90407-2138, USA.

N Engl J Med. 2002 Mar 14;346(11):830-5. doi: 10.1056/NEJMsa122601.

BACKGROUND

Several states have developed prescription-drug discount programs for Medicare beneficiaries. In California, Senate Bill 393, enacted in 1999, requires pharmacies participating in the state Medicaid program (Medi-Cal) to charge customers who present a Medicare card amounts based on Medi-Cal rates. Because Medicare beneficiaries may not be accustomed to presenting their Medicare cards at pharmacies, we assessed the compliance of pharmacies with Senate Bill 393.

METHODS

Fifteen Medicare beneficiaries who received special training and acted as "standardized patients" visited a random sample of pharmacies in the San Francisco Bay area and Los Angeles County in April and May 2001. According to a script, they asked for the prices of three commonly prescribed drugs: rofecoxib, sertraline, and atorvastatin. The script enabled us to determine whether and when, during their interactions with pharmacists or salespeople, the discounts specified in Senate Bill 393 were offered. Pharmacies at which the appropriate discounts were offered were considered compliant.

RESULTS

The patients completed visits to 494 pharmacies. Seventy-five percent of the pharmacies complied with the prescription-drug discount program; at only 45 percent, however, was the discount offered before it was specifically requested. The discount was offered at 91 percent of pharmacies that were part of a chain, as compared with 58 percent of independent pharmacies (P<0.001). Compliance was higher in the San Francisco Bay area than in Los Angeles County (84 percent vs. 72 percent, P=0.004) and was higher in high-income than low-income neighborhoods (81 percent vs. 69 percent, P=0.002). A Medicare beneficiary taking all three drugs would have saved an average of $55.70 per month as compared with retail prices (a savings of 20 percent).

CONCLUSIONS

Discounts required under California's prescription-drug discount program for Medicare beneficiaries offer substantial savings. Many patients, however, especially those who use independent pharmacies or who live in low-income neighborhoods, may not receive the discounts.

背景

有几个州已经为医疗保险受益人制定了处方药折扣计划。在加利福尼亚州，1999年颁布的参议院法案393要求参与该州医疗补助计划（医疗救助）的药店，向出示医疗保险卡的顾客收取基于医疗救助费率的费用。由于医疗保险受益人可能不习惯在药店出示他们的医疗保险卡，我们评估了药店对参议院法案393的遵守情况。

方法

2001年4月和5月，15名接受过特殊培训并充当“标准化病人”的医疗保险受益人走访了旧金山湾区和洛杉矶县的随机抽取的一批药店。按照一份脚本，他们询问了三种常用处方药的价格：罗非昔布、舍曲林和阿托伐他汀。该脚本使我们能够确定在他们与药剂师或销售人员的互动过程中，参议院法案393规定的折扣是否以及何时被提供。提供了适当折扣的药店被视为符合规定。

结果

这些病人完成了对494家药店的走访。75%的药店遵守了处方药折扣计划；然而，只有45%的药店在被特别要求之前就提供了折扣。连锁药店中有91%提供了折扣，相比之下独立药店为58%（P<0.001）。旧金山湾区的遵守情况高于洛杉矶县（84%对72%，P=0.004），高收入社区的遵守情况高于低收入社区（81%对69%，P=0.002）。与零售价相比，一名服用所有三种药物的医疗保险受益人每月平均可节省55.70美元（节省20%）。