School of Pharmacy, University of Colorado Denver , Denver, CO 80045, USA.
Popul Health Manag. 2010 Oct;13(5):235-45. doi: 10.1089/pop.2009.0066.
The objective of this study was to examine the impact of reducing the prescription co-pay for diabetes medications on pharmacy utilization, medication adherence, medical utilization, and expenditures. The co-pay reduction involved placing all diabetic drugs and testing supplies on the lowest co-pay tier for one employer group. The sample comprised members with diabetes who were both continuously enrolled in the 12-month pre period and the 2 years following co-pay reduction. Measured outcomes included diabetic prescription utilization, medication adherence, medical utilization, and expenditures. Generalized estimating equations for repeated measures were used to estimate differences between the pre period and years 1 and 2, while adjusting for age, sex, and comorbidity risk. Diabetic prescription utilization and medication adherence increased by approximately 3.0% in year 1 and dropped in year 2. The increases were primarily in brand name diabetes medications, which increased by approximately 5%, while generic use decreased in both years. Decreases in emergency room visits and hospitalizations were also observed in both years, followed by a decrease in health care expenditures in year 2. Adherent members experienced greater decreases in emergency room visits following the co-pay reduction compared to nonadherent members. After the implementation of a co-pay reduction, a modest increase in adherence and use of diabetes medications was observed. There were some compensatory cost savings for the employer from lower medical expenditures in year 1. In addition to financial strategies, additional strategies to reinforce medication adherence are needed to gain and sustain more meaningful increases in prescription utilization.
本研究旨在考察降低糖尿病药物处方共付额对药房利用率、药物依从性、医疗利用率和支出的影响。共付额的降低包括将所有糖尿病药物和检测用品都纳入一个雇主群体的最低共付额层级。样本包括在 12 个月的预期间和共付额降低后的 2 年中连续参保的糖尿病患者。测量结果包括糖尿病处方利用率、药物依从性、医疗利用率和支出。使用重复测量的广义估计方程来估计预期间和第 1 年和第 2 年之间的差异，同时调整年龄、性别和合并症风险。第 1 年糖尿病处方利用率和药物依从性增加了约 3.0%，第 2 年则下降。增加主要发生在品牌名糖尿病药物，增加了约 5%，而通用名药物的使用在两年中都有所下降。第 1 年和第 2 年还观察到急诊室就诊和住院次数减少，随后第 2 年医疗支出也减少。共付额降低后，依从性较高的患者急诊室就诊次数减少幅度大于依从性较低的患者。在实施共付额降低后，观察到糖尿病药物的依从性和使用率略有增加。第 1 年医疗支出的降低为雇主带来了一些成本节约。除了财务策略外，还需要采取额外的策略来加强药物依从性，以获得并维持更有意义的处方利用率的增加。
