Shrank William H, Fox Sarah A, Kirk Adele, Ettner Susan L, Cantrell Clairessa H, Glassman Peter, Asch Steven M
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
J Gen Intern Med. 2006 Apr;21(4):334-9. doi: 10.1111/j.1525-1497.2006.00402.x.
Incentive-based formularies have been widely instituted to control the rising costs of prescription drugs. To work properly, such formularies depend on patients to be aware of financial incentives and communicate their cost preferences with prescribing physicians. The impact of financial incentives on patient awareness of and communication about those costs is unknown.
To evaluate the relationship between enrollment in incentive-based pharmacy benefit plans and awareness of out-of-pocket costs and rates of communication about out-of-pocket costs.
A matched telephone survey of patients and their primary care physicians.
Los Angeles County.
One thousand nine hundred and seventeen patients aged 53 to 82 (73% response rate).
Patient-reported pharmacy benefit design, knowledge of out-of-pocket costs, and discussion of out-of-pocket costs with physicians.
Sixty-two percent of patients who had prescription drug coverage and were aware of their pharmacy benefit design reported being enrolled in incentive-based plans. The majority of these (54%) were "never" or only "sometimes" aware of their out-of-pocket cost requirements at the time of the physician visit. After controlling for numerous physician and patient level variables, we found that patients enrolled in pharmacy benefit designs requiring no copayments were more likely to report they "never" discuss out-of-pocket costs with physicians compared with patients enrolled in incentive-based pharmacy benefit designs (81% vs 67%, P=.001) and patients with no prescription drug insurance (57%, P<.001).
Incentive-based pharmacy benefit plans and lack of insurance are associated with increased rates of discussions about out-of-pocket costs. Nonetheless, most incentive-based enrollees are unaware of out-of-pocket costs when prescriptions are written and never discuss out-of-pocket costs with their physicians, likely mitigating the effectiveness of financial incentives to guide decision making. Considering that out-of-pocket costs are associated with adherence to medical therapy, interventions to improve patient access to out-of-pocket cost information and the frequency of patient-physician discussions about costs are needed.
基于激励措施的药品处方集已被广泛采用，以控制处方药成本的不断上涨。为了正常发挥作用，此类处方集依赖于患者了解经济激励措施，并与开处方的医生沟通他们对成本的偏好。经济激励措施对患者对这些成本的认知及相关沟通的影响尚不清楚。
评估参与基于激励措施的药房福利计划与自付费用意识及自付费用沟通率之间的关系。
对患者及其初级保健医生进行配对电话调查。
洛杉矶县。
1917名年龄在53至82岁之间的患者（回复率73%）。
患者报告的药房福利设计、自付费用知识以及与医生讨论自付费用的情况。
有处方药保险且了解其药房福利设计的患者中，62%报告参加了基于激励措施的计划。其中大多数（54%）在看医生时“从未”或只是“有时”了解其自付费用要求。在控制了众多医生和患者层面的变量后，我们发现，与参加基于激励措施的药房福利计划的患者（81%对67%，P = 0.001）以及没有处方药保险的患者（57%，P < 0.001）相比，参加无需自付费用的药房福利设计的患者更有可能报告他们“从未”与医生讨论自付费用。
基于激励措施的药房福利计划和缺乏保险与自付费用讨论率的增加有关。尽管如此，大多数参加基于激励措施计划的人在开处方时并不了解自付费用，也从未与他们的医生讨论过自付费用，这可能会削弱经济激励措施在指导决策方面的有效性。鉴于自付费用与坚持药物治疗有关，需要采取干预措施，以改善患者获取自付费用信息的机会，并增加患者与医生讨论费用的频率。
