Cox Emily R, Henderson Rochelle R
Office of Research and Planning, Express Scripts, Inc., 13900 Riverport Dr., Maryland Heights, MO 63043, USA.
J Manag Care Pharm. 2002 Sep-Oct;8(5):360-4. doi: 10.18553/jmcp.2002.8.5.360.
To evaluate the strategies Medicare beneficiaries adopt to manage their out-of-pocket prescription costs in a prescription drug plan with maximum (.capped.) benefits and to evaluate differences in the likelihood of participating in any one strategy before and after exhaustion of capped prescription benefits.
Self-administered surveys were mailed to 786 Medicare+Choice members with capped annual prescription drug benefits of 500 dollars or 1,000 dollars.
Two hundred twenty-one surveys were returned, for a 28% response rate. More than 70% of respondents participated in at least one strategy to manage prescription costs. The most frequently reported strategies included obtaining samples from their physician (45%), reducing spending on food and/or clothing (37%), shopping around at other pharmacies to obtain medications at a lower cost (29%), taking less than the prescribed amount (24%), receiving financial assistance from family or friends (17%), and stopping one or more regular-use medications (15%). More than two thirds of those who participated in at least one strategy participated in 2 or more strategies. While the combinations of strategies suggested prudence on the part of respondents (e.g., obtaining samples, shopping around), a subset of respondents participated in strategies that would be considered less desirable (e.g., stopping medications and taking less than prescribed). Finally, more than 35% indicated that they did not know their cap amount, and 24% did not know whether they had exhausted their benefit in 2000.
These findings highlight the difficulties many Medicare beneficiaries face in managing prescription costs, even those with some coverage for prescription costs. In the design of prescription coverage for the elderly, policy makers should recognize the impact that capped benefits have on member behavior. The apparent high rate of reliance upon prescription drug samples to reduce prescription drug expenditures for many Medicare+Choice members raises the question of whether prescription drug samples may discourage the prescribing of lower-cost therapeutic alternatives.
评估医疗保险受益人在具有最高（封顶）福利的处方药计划中用于管理自付处方药费用的策略，并评估在封顶处方药福利用尽前后参与任何一种策略的可能性差异。
自行填写的调查问卷被邮寄给786名医疗保险+选择计划的成员，这些成员的年度处方药福利封顶金额为500美元或1000美元。
共收回221份调查问卷，回复率为28%。超过70%的受访者参与了至少一种管理处方药费用的策略。最常被提及的策略包括从医生处获取样品（45%）、减少食品和/或衣物支出（37%）、在其他药店四处比较以较低成本购药（29%）、服用少于规定剂量（24%）、接受家人或朋友的经济援助（17%）以及停用一种或多种常用药物（15%）。参与了至少一种策略的受访者中，超过三分之二参与了两种或更多策略。虽然这些策略组合表明受访者较为谨慎（例如获取样品、四处比较），但有一部分受访者参与了一些不太可取的策略（例如停药、服用少于规定剂量）。最后，超过35%的受访者表示他们不知道自己的封顶金额，24%的受访者不知道他们在2000年是否已用尽福利。
这些发现凸显了许多医疗保险受益人在管理处方药费用方面面临的困难，即使是那些享有一定处方药费用 coverage 的人。在为老年人设计处方药保险时，政策制定者应认识到封顶福利对成员行为的影响。许多医疗保险+选择计划成员明显高度依赖处方药样品来降低处方药支出，这引发了一个问题，即处方药样品是否可能阻碍较低成本治疗替代方案的处方开具。
