基于激励措施的药品处方集对处方药使用及支出的影响。

The effect of incentive-based formularies on prescription-drug utilization and spending.

作者信息

Huskamp Haiden A, Deverka Patricia A, Epstein Arnold M, Epstein Robert S, McGuigan Kimberly A, Frank Richard G

机构信息

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.

出版信息

N Engl J Med. 2003 Dec 4;349(23):2224-32. doi: 10.1056/NEJMsa030954.

DOI:10.1056/NEJMsa030954

PMID:14657430

Abstract

BACKGROUND

Many employers and health plans have adopted incentive-based formularies in an attempt to control prescription-drug costs.

METHODS

We used claims data to compare the utilization of and spending on drugs in two employer-sponsored health plans that implemented changes in formulary administration with those in comparison groups of enrollees covered by the same insurers. One plan simultaneously switched from a one-tier to a three-tier formulary and increased all enrollee copayments for medications. The second switched from a two-tier to a three-tier formulary, changing only the copayments for tier-3 drugs. We examined the utilization of angiotensin-converting-enzyme (ACE) inhibitors, proton-pump inhibitors, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins).

RESULTS

Enrollees covered by the employer that implemented more dramatic changes experienced slower growth than the comparison group in the probability of the use of a drug and a major shift in spending from the plan to the enrollee. Among the enrollees who were initially taking tier-3 statins, more enrollees in the intervention group than in the comparison group switched to tier-1 or tier-2 medications (49 percent vs. 17 percent, P<0.001) or stopped taking statins entirely (21 percent vs. 11 percent, P=0.04). Patterns were similar for ACE inhibitors and proton-pump inhibitors. The enrollees covered by the employer that implemented more moderate changes were more likely than the comparison enrollees to switch to tier-1 or tier-2 medications but not to stop taking a given class of medications altogether.

CONCLUSIONS

Different changes in formulary administration may have dramatically different effects on utilization and spending and may in some instances lead enrollees to discontinue therapy. The associated changes in copayments can substantially alter out-of-pocket spending by enrollees, the continuation of the use of medications, and possibly the quality of care.

摘要

背景

许多雇主和健康计划采用了基于激励措施的处方集，试图控制处方药成本。

方法

我们使用索赔数据，比较了两个雇主赞助的健康计划中药物的使用情况和支出，这两个计划对处方集管理进行了更改，并与由相同保险公司承保的参保者对照组进行了比较。一个计划同时从单层处方集转换为三层处方集，并提高了所有参保者的药物自付费用。第二个计划从两层处方集转换为三层处方集，仅改变了三层药物的自付费用。我们研究了血管紧张素转换酶（ACE）抑制剂、质子泵抑制剂和3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）的使用情况。

结果

实施了更显著变化的雇主所覆盖的参保者，在使用药物的概率以及支出从计划向参保者的重大转移方面，增长速度比对照组慢。在最初服用三层他汀类药物的参保者中，干预组中转向一层或二层药物的参保者比对照组更多（49%对17%，P<0.001），或者完全停止服用他汀类药物的参保者也更多（21%对11%，P=0.04）。ACE抑制剂和质子泵抑制剂的模式相似。实施了较温和变化的雇主所覆盖的参保者比对照参保者更有可能转向一层或二层药物，但不太可能完全停止服用某类药物。