Conwell Leslie Jackson, Esposito Dominick, Garavaglia Susan, Meadows Eric S, Colby Margaret, Herrera Vivian, Goldfarb Seth, Ball Daniel, Marciniak Martin
Mathematica Policy Research, Inc., Washington, DC, USA.
Am J Geriatr Pharmacother. 2011 Aug;9(4):241-9. doi: 10.1016/j.amjopharm.2011.04.009. Epub 2011 May 26.
The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during this coverage gap.
The purpose of this study was to investigate changes in out-of-pocket (OOP) drug costs and utilization associated with the Medicare Part D coverage gap among postmenopausal beneficiaries with osteoporosis.
This retrospective analysis of 2007 pharmacy claims focuses on postmenopausal female Medicare beneficiaries enrolled in full-, partial-, or no-gap exposure standard or Medicare Advantage prescription drug plans (PDPs), retiree drug subsidy (RDS) plans, or the low-income subsidy program. We compared beneficiaries with osteoporosis who were taking teriparatide (Eli Lilly and Company, Indianapolis, Indiana) (n = 5657) with matched samples of beneficiaries who were taking nonteriparatide osteoporosis medications (NTO; n = 16,971) or who had other chronic conditions (OCC; n = 16,971). We measured average monthly prescription drug fills and OOP costs, medication discontinuation, and skipping.
More than half the sample reached the coverage gap; OOP costs then rose for teriparatide users enrolled in partial- or full-gap exposure plans (increase of 121% and 186%; $300 and $349) but fell for those in no-gap exposure PDPs or RDS plans (decrease of 49% and 30%; $131 and $40). OOP costs for beneficiaries in partial- or full-gap exposure PDPs increased >120% (increase of $144 and $176) in the NTO group and nearly doubled for the OCC group (increase of $124 and $151); these OOP costs were substantially lower than those for teriparatide users. Both teriparatide users and NTO group members discontinued or skipped medications more often than persons in the OCC group, regardless of plan or benefit design.
Medication discontinuation and OOP costs among beneficiaries with osteoporosis were highest for those enrolled in Part D plans with a coverage gap. Providers should be aware of potential cost-related nonadherence among Medicare beneficiaries taking osteoporosis medications.
医疗保险D部分的覆盖缺口与较低的依从性、药物使用以及较高的停药率相关。由于骨质疏松症在符合医疗保险资格的绝经后妇女中患病率相对较高，我们研究了在此覆盖缺口期间骨质疏松症药物使用情况的变化。
本研究的目的是调查患有骨质疏松症的绝经后受益人群中，与医疗保险D部分覆盖缺口相关的自付药费和药物使用情况的变化。
这项对2007年药房报销记录的回顾性分析，聚焦于参加全缺口、部分缺口或无缺口暴露标准的医疗保险优势处方药计划（PDP）、退休人员药物补贴（RDS）计划或低收入补贴计划的绝经后女性医疗保险受益人。我们将服用特立帕肽（礼来公司，印第安纳波利斯，印第安纳州）的骨质疏松症受益人（n = 5657）与服用非特立帕肽骨质疏松症药物的匹配样本受益人（NTO；n = 16,971）或患有其他慢性病的受益人（OCC；n = 16,971）进行比较。我们测量了每月平均处方药配药次数、自付费用、药物停药情况和漏服情况。
超过一半的样本进入了覆盖缺口；对于参加部分缺口或全缺口暴露计划的特立帕肽使用者，自付费用随后有所上升（分别增加121%和186%；300美元和349美元），但对于参加无缺口暴露PDP或RDS计划的使用者，自付费用下降了（分别下降49%和30%；131美元和40美元）。在部分缺口或全缺口暴露PDP中的受益人的自付费用，在NTO组中增加了超过120%（分别增加144美元和176美元），在OCC组中几乎翻倍（分别增加124美元和151美元）；这些自付费用大大低于特立帕肽使用者的费用。无论计划或福利设计如何，特立帕肽使用者和NTO组成员停药或漏服药物的频率都高于OCC组中的人员。
对于参加有覆盖缺口的D部分计划的骨质疏松症受益人，药物停药率和自付费用最高。医疗服务提供者应意识到服用骨质疏松症药物的医疗保险受益人中与费用相关的潜在不依从情况。
