Centers for Medicare and Medicaid Services, Baltimore, MD 21244, USA.
J Am Soc Nephrol. 2012 May;23(5):959-65. doi: 10.1681/ASN.2011070740. Epub 2012 Mar 8.
Despite extensive use of prescription medications in ESRD, relatively little is known about the participation of Medicare ESRD beneficiaries in the Part D program. Here, we quantitated the sources of drug coverage among ESRD beneficiaries and explored the Part D plan preferences of ESRD beneficiaries with regard to deductibles, coverage gaps, and monthly premiums. We obtained data on beneficiary sources of creditable coverage, characteristics of Part D plans, demographics, and residence from the Centers for Medicare and Medicaid Chronic Condition Data Warehouse and identified beneficiaries with ESRD from the US Renal Data System. We found that a substantial proportion (17.0%) of ESRD beneficiaries lacked a known source of creditable drug coverage in 2007 and 64.3% were enrolled in Part D. Of those enrolled, 72% received the Medicare Part D low-income subsidy. ESRD beneficiaries who enrolled in standalone Part D plans without the assistance of the low-income subsidy tended to prefer more comprehensive coverage options. In conclusion, more outreach is needed to ensure that beneficiaries who lack coverage obtain the coverage they need and that ESRD beneficiaries join the best plans for managing their disease and accompanying comorbid conditions.
尽管在终末期肾病（ESRD）中广泛使用处方药物，但对于医疗保险 ESRD 受益人的参与情况，人们知之甚少。在这里，我们定量评估了 ESRD 受益人的药物覆盖来源，并探讨了 ESRD 受益人的 Part D 计划偏好，包括免赔额、覆盖缺口和月费。我们从医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）的慢性疾病数据仓库中获得了受益人的信用覆盖来源、Part D 计划的特征、人口统计学和居住信息，并从美国肾脏数据系统（US Renal Data System）中确定了 ESRD 受益人的信息。我们发现，在 2007 年，相当一部分（17.0%）ESRD 受益人的信用药物覆盖来源未知，而 64.3%的人参加了 Part D 计划。在参加该计划的人群中，有 72%的人获得了医疗保险 Part D 低收入补贴。在没有低收入补贴帮助的情况下，参加独立的 Part D 计划的 ESRD 受益人群更倾向于选择更全面的覆盖选项。总之，需要进行更多的宣传，以确保没有覆盖的受益人获得所需的覆盖，并确保 ESRD 受益人群加入最适合管理其疾病和伴随的合并症的计划。
