Universit of Colorado, School of Pharmacy, Aurora, CO 80045, USA.
Am J Manag Care. 2011 Oct;17(10):703-10.
Unintended consequences may result from changes in pharmacy benefit design. The objective was to determine the impact of increasing patient prescription copayments for guideline recommended, long-term asthma controller (LTC) medications on asthma-related medication use and healthcare services.
We used 2005 MarketScan healthcare and pharmacy claims data to identify asthma (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] diagnosis code 493.xx) patients aged 12 to 64 years who were continuously enrolled through 2006 with ≥ 1 claim for an asthma medication in 2005. LTCs included: inhaled corticosteroid (ICS) (n = 10,251), ICS plus long-acting beta agonist (COMBO) (n =27,407), and leukotriene receptor antagonist (LTRA) (n = 20,664).
Using multivariable models, we estimated the associations between changes in LTC copayments and LTC consumption and asthma-related outpatient and emergency department (ED) visits.
Patients were dichotomized into ≥ $5 average increase in patient copayments per month of medication supplied (yes/no). The mean annual change (2005-2006) in copayments per month was $13.23 versus -$3.88 (ICS), $11.76 versus -$3.06 (COMBO), and $9.78 versus -$2.06 (LTRA). The ≥ $5 group experienced a significant decline in average annual days of medication supplied of -47.1 days of ICS (95% CI -43.5 to -50.8), -35.3 days of COMBO (-32.4 to -38.2), and -47.5 days of LTRA (-43.2 to -51.7). Among COMBO and LTRA medication users, the ≥ $5 copayment increase was associated with more asthma-related outpatient visits and ED visits compared with the < $5 group.
The findings suggest that even small changes in average copayment for asthma medications can result in significant reductions in medication use and unintended increases in healthcare services.
药物福利方案的改变可能会产生意想不到的后果。本研究旨在确定增加指南推荐的长期哮喘控制药物（LTC）患者处方共付额对哮喘相关药物使用和医疗服务的影响。
我们使用了 2005 年 MarketScan 医疗保健和药房理赔数据，以确定年龄在 12 至 64 岁之间的哮喘（国际疾病分类第 9 版临床修订版[ICD-9-CM]诊断代码 493.xx）患者，这些患者在 2006 年期间持续入组，并且在 2005 年至少有一次哮喘药物理赔。LTC 包括：吸入皮质类固醇（ICS）（n=10251）、ICS 加长效β激动剂（COMBO）（n=27407）和白三烯受体拮抗剂（LTRA）（n=20664）。
使用多变量模型，我们估计了 LTC 共付额变化与 LTC 消费以及哮喘相关门诊和急诊（ED）就诊之间的关联。
患者被分为每月用药供应的患者共付额增加≥$5（是/否）。每月共付额的年平均变化（2005-2006 年）为 ICS 为$13.23 对-$3.88、COMBO 为$11.76 对-$3.06，以及 LTRA 为$9.78 对-$2.06。≥$5 组的平均每年用药供应天数显著减少了 47.1 天 ICS（95%CI 为 43.5 至 50.8）、35.3 天 COMBO（32.4 至 38.2）和 47.5 天 LTRA（43.2 至 51.7）。在 COMBO 和 LTRA 药物使用者中，与<$5 组相比，共付额增加≥$5 与更多的哮喘相关门诊就诊和 ED 就诊相关。
这些发现表明，即使哮喘药物的平均共付额略有增加，也可能导致药物使用量显著减少和医疗服务的意外增加。
