Section of General Internal Medicine, Department of Medicine, and Center for Health and the Social Sciences, University of Chicago, IL, USA.
Health Serv Res. 2010 Feb;45(1):133-51. doi: 10.1111/j.1475-6773.2009.01065.x. Epub 2009 Dec 4.
To examine the effect of Part D on 65-78-year-old noninstitutionalized dual eligibles' prescription utilization and expenditures.
Random sample of unique pharmacy customers of a national retail pharmacy chain who filled at least one prescription during both 2005 and 2006. For each subject, we obtained claims data for every prescription filled between January 1, 2005, and April 31, 2007.
Generalized estimating equations were used to examine the experience of a "treatment" group (dual eligibles between 65 and 78 years on January 1, 2005) with that of a "control" group (near-elderly patients with Medicaid coverage between 60 and 63 years on January 1, 2005) during the first 18 months after Part D implementation.
Expenditures for the treatment and control groups tracked each other closely in the pre-Part D period. Immediately following the implementation of Part D, expenditures for both groups decreased and then leveled off. There were no significant changes in trends in the dual eligibles' out-of-pocket expenditures, total monthly expenditures, pill-days, or total number of prescriptions due to Part D.
We find no evidence that Part D adversely affected pharmaceutical utilization or out-of-pocket expenditures of dual eligibles during the transition period, nor during the 16 months subsequent to Part D implementation.
考察医疗保险处方药补贴计划（Part D）对 65-78 岁、非住院的双重资格受益人的处方使用和支出的影响。
全国零售连锁药店的独特药房顾客的随机抽样，这些顾客在 2005 年和 2006 年期间至少有一次处方。对于每个受试者，我们获得了在 2005 年 1 月 1 日至 2007 年 4 月 31 日期间填写的每一张处方的理赔数据。
使用广义估计方程来研究“治疗”组（2005 年 1 月 1 日年龄在 65-78 岁之间的双重资格受益者）与“对照”组（2005 年 1 月 1 日年龄在 60-63 岁之间、有医疗补助覆盖的接近老年患者）在 Part D 实施后的前 18 个月内的经历。
在 Part D 实施之前，治疗组和对照组的支出密切相关。在 Part D 实施后，两组的支出立即下降，然后趋于平稳。由于 Part D，双重资格受益人的自付支出、总月支出、用药天数或总处方数量都没有明显的变化趋势。
我们没有发现证据表明 Part D 在过渡期间或 Part D 实施后的 16 个月内对双重资格受益人的药物利用或自付支出产生了不利影响。
