Shrank William H, Patrick Amanda R, Pedan Alex, Polinski Jennifer M, Varasteh Laleh, Levin Raisa, Liu Nan, Schneeweiss Sebastian
Department of Medicine, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA.
J Am Geriatr Soc. 2008 Dec;56(12):2304-10. doi: 10.1111/j.1532-5415.2008.02025.x.
To evaluate medication use, out-of-pocket spending, and medication switching during the transition period for patients dually eligible for Medicaid and Medicare (dual eligibles).
Time-trend analysis, using segmented linear regression.
Patient-level pharmacy dispensing data from January 2005 to December 2006 from a large pharmacy chain with stores in 34 states.
Dual eligibles aged 65 and older.
Changes in utilization, patient copayments, and medication switching were analyzed using interrupted time trend analyses. Utilization and spending were evaluated for five study drugs: clopidogrel, proton pump inhibitors (PPIs), warfarin, and statins (essential drugs covered by Part D plans) and benzodiazepines (not covered through Part D but potentially covered through Medicaid).
Drug use for 13,032 dual eligibles was evaluated. There was no significant effect of the transition to Medicare Part D on use of all study drugs, including the uncovered benzodiazepines. Cumulative reductions were seen in copayments for all covered drugs after implementation of Part D, ranging from 25% annually for PPIs to 53% for warfarin, but there was a larger increase in copayments, 91% annually, for benzodiazepines after the transition. The rate of switching medications was 3.0 times as great for the PPIs after implementation of Part D than before implementation, but there was no significant change in the other study drug classes.
These findings in a single, large pharmacy chain indicate that the transition plan for dual eligibles led to less medication discontinuation and switching than many had expected. The substantially greater cost sharing for benzodiazepines highlights the importance of implementing a thoughtful transition plan when executing such a national policy.
评估同时符合医疗补助（Medicaid）和医疗保险（Medicare）资格的患者（双重资格患者）在过渡期的药物使用、自付费用及药物转换情况。
采用分段线性回归的时间趋势分析。
来自一家大型连锁药店2005年1月至2006年12月的患者层面药房配药数据，该连锁药店在34个州设有门店。
65岁及以上的双重资格患者。
使用间断时间趋势分析来分析使用情况、患者自付费用及药物转换的变化。对五种研究药物的使用和费用进行了评估：氯吡格雷、质子泵抑制剂（PPI）、华法林和他汀类药物（D部分计划涵盖的基本药物）以及苯二氮䓬类药物（D部分未涵盖，但可能由医疗补助覆盖）。
对13,032名双重资格患者的药物使用情况进行了评估。向医疗保险D部分的过渡对所有研究药物的使用没有显著影响，包括未涵盖的苯二氮䓬类药物。D部分实施后，所有涵盖药物的自付费用累计减少，PPI每年减少25%，华法林减少53%，但过渡后苯二氮䓬类药物的自付费用每年大幅增加91%。D部分实施后，PPI的药物转换率比实施前高3.0倍，但其他研究药物类别没有显著变化。
在一家大型连锁药店的这些发现表明，双重资格患者的过渡计划导致的药物停用和转换比许多人预期的要少。苯二氮䓬类药物大幅增加的费用分担凸显了在执行此类国家政策时实施周全过渡计划的重要性。
