Huskamp Haiden A, Deverka Patricia A, Landrum Mary Beth, Epstein Robert S, McGuigan Kimberly A
Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115, USA.
Health Serv Res. 2007 Oct;42(5):1926-42. doi: 10.1111/j.1475-6773.2007.00722.x.
To assess the effect of three-tier formulary adoption on medication continuation and spending among elderly members of retiree health plans.
Pharmacy claims and enrollment data on elderly members of four retiree plans that adopted a three-tier formulary over the period July 1999 through December 2002 and two comparison plans that maintained a two-tier formulary during this period.
We used a quasi-experimental design to compare the experience of enrollees in intervention and comparison plans. We used propensity score methods to match intervention and comparison users of each drug class and plan. We estimated repeated measures regression models for each class/plan combination for medication continuation and monthly plan, enrollee, and total spending. We estimated logit models of the probability of nonpersistent use, medication discontinuation, and medication changes.
DATA COLLECTION/EXTRACTION METHODS: We used pharmacy claims to create person-level drug utilization and spending files for the year before and year after three-tier adoption.
Three-tier formulary adoption resulted in shifting of costs from plan to enrollee, with relatively small effects on medication continuation. Although implementation had little effect on continuation on average, a small minority of patients were more likely to have gaps in use and discontinue use relative to comparison patients.
Moderate cost sharing increases from three-tier formulary adoption had little effect on medication continuation among elderly enrolled in retiree health plans with relatively generous drug coverage.
评估采用三层药品目录对退休人员健康计划中老年成员的药物持续使用情况和费用支出的影响。
1999年7月至2002年12月期间采用三层药品目录的四个退休人员计划中老年成员的药房报销数据和参保数据，以及在此期间维持两层药品目录的两个对照计划的数据。
我们采用准实验设计来比较干预组和对照组参保人员的情况。我们使用倾向得分方法对每个药物类别和计划的干预组和对照组使用者进行匹配。我们针对每个类别/计划组合，估计了用于药物持续使用情况以及每月计划、参保人员和总费用支出的重复测量回归模型。我们估计了非持续用药、停药和换药概率的logit模型。
数据收集/提取方法：我们利用药房报销数据创建了采用三层药品目录之前一年和之后一年的个人层面药物使用和费用支出文件。
采用三层药品目录导致成本从计划方转移到参保人员方，对药物持续使用情况的影响相对较小。虽然实施总体上对持续用药影响不大，但相对于对照患者，一小部分患者更有可能出现用药间断和停药情况。
对于参加药物覆盖范围相对宽松的退休人员健康计划的老年人而言，采用三层药品目录适度增加成本分担对药物持续使用情况影响不大。
