Fairman Kathleen A, Motheral Brenda R, Henderson Rochelle R
Express Scripts, Inc, Maryland Heights, Missouri 63043, USA.
Clin Ther. 2003 Dec;25(12):3147-61; discussion 3144-6. doi: 10.1016/s0149-2918(03)90099-3.
Previous research has suggested that 3-tier prescription drug copayment systems produce drug cost savings without affecting the use of other medical services during the first 12 months after implementation. Assessment of such systems with a longer follow-up period has been needed.
This study examined the effect of a 3-tier copayment system on pharmaceutical and medical utilization and cost for 30 months after implementation in a population of commercially insured, preferred-provider organization members.
This was a quasi-experimental, pre-post with comparison group design that gathered data retrospectively from the claims database of a preferred-provider organization in the Midwestern United States. The intervention group comprised members whose employer switched from a 2-tier (generic/brand copayment) plan to a 3-tier (generic/formulary/nonformulary) plan. The comparison group comprised members whose employer retained the 2-tier plan. Employers did not offer a choice between the 2- and 3-tier plans. Outcome measures included total drug cost; net insurer cost (drug cost minus copayment); number of prescription claims; numbers of office visits, inpatient hospitalizations, and emergency department visits; and rates of continuation with chronic medication therapy.
Relative to the comparison group (n=4132), the intervention group (n=3577) showed reduced growth in net cost and lower utilization of third-tier (nonformulary) medications (P<0.001 and P<0.01, respectively). The intervention and comparison groups did not differ significantly with respect to numbers of office visits, emergency department visits, or inpatient hospitalizations. Medication continuation rates were lower for the intervention than the comparison group at 6 months for oral contraceptives (P<0.05), but chronic medication therapy continuation rates did not differ significantly at any other time point or for estrogens, antihypertensives, or antihyperlipidemics.
In the population studied, previous research findings were confirmed over a longer time period.
先前的研究表明，三层级处方药共付系统在实施后的头12个月内可节省药品成本，且不影响其他医疗服务的使用。因此需要对这类系统进行更长随访期的评估。
本研究调查了三层级共付系统对商业保险的优选医疗机构成员群体实施30个月后的药品及医疗利用情况和成本的影响。
这是一项准实验性的前后对照且设有对照组的设计，通过回顾性收集美国中西部一个优选医疗机构的理赔数据库中的数据进行研究。干预组由其雇主从两层级（通用名/品牌药共付）计划转换为三层级（通用名/医保目录内/医保目录外）计划的成员组成。对照组由其雇主保留两层级计划的成员组成。雇主并未在两层级和三层级计划之间提供选择。结局指标包括总药品成本；净保险人成本（药品成本减去共付费用）；处方索赔数量；门诊就诊次数、住院次数和急诊就诊次数；以及慢性药物治疗的持续率。
相对于对照组（n = 4132），干预组（n = 3577）的净成本增长降低，且第三层级（医保目录外）药物的使用减少（分别为P < 0.001和P < 0.01）。干预组和对照组在门诊就诊次数、急诊就诊次数或住院次数方面无显著差异。干预组口服避孕药在6个月时的药物持续率低于对照组（P < 0.05），但在任何其他时间点，雌激素、抗高血压药或抗高血脂药的慢性药物治疗持续率无显著差异。
在所研究的人群中，先前的研究结果在更长时间段内得到了证实。
