Pharmaceutical Health Services Research Department, The Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Med Care. 2012 Nov;50(11):913-9. doi: 10.1097/MLR.0b013e31826c85f9.
It is not known whether low-income subsidies (LIS) under Medicare Part D help beneficiaries overcome impediments to medication use associated with poor socioeconomic status and high disease burden.
To compare Medicare beneficiaries with LIS and Medicaid (duals), LIS without dual eligibility, and non-LIS recipients on use of medications recommended in diabetes treatment.
Fixed-effect comparisons among beneficiaries in the same Part D plans in 2006-2007.
Nationally representative sample of enrollees in Part D prescription drug plans. A total of 109,292 beneficiaries were in 204 prescription drug plans; 47.5% non-LIS, 44.4% duals, and 8.1% nondual LIS recipients.
Medications included antidiabetic agents, renin-angiotensin-aldosterone system inhibitors, and antihyperlipidemics. Drug use was measured by exposure, duration of therapy, and medication possession ratio.
The LIS dual cohort had significantly higher comorbidity compared with non-LIS comparisons, LIS nonduals were significantly more likely to take medications in all 3 drug classes compared with non-LIS recipients, but differences were small (between 2% and 4%; P<0.05). Non-LIS recipients and duals had equivalent exposure to any antidiabetic drug and antihyperlipidemics, but duals were 3% less likely to receive renin-angiotensin-aldosterone system inhibitors compared with non-LIS recipients (P<0.05). Small differences in adjusted values for duration of therapy and medication possession ratio among the 3 cohorts were also observed, none of which were clinically meaningful.
Similarities in medication utilization among Part D enrollees with and without LIS coverage supports the program objective of providing enhanced access to needed medications for diverse groups of Medicare beneficiaries.
尚不清楚医疗保险处方药计划部分 D 下的低收入补贴（LIS）是否有助于受益人为克服与较差的社会经济地位和高疾病负担相关的药物使用障碍。
比较在药物使用方面具有 LIS 和医疗补助（双重资格）、LIS 但无双重资格以及无 LIS 受益人的医疗保险受益人的情况，这些药物使用建议用于糖尿病治疗。
在 2006-2007 年，对同一部分 D 计划中的受益人进行固定效应比较。
参加处方药计划的医疗保险部分的全国代表性样本。共有 109292 名受益人参加了 204 个处方药计划；47.5%无 LIS，44.4%双重资格，8.1%无双重 LIS 受益人。
药物包括抗糖尿病药物、肾素-血管紧张素-醛固酮系统抑制剂和抗高血脂药。药物使用通过暴露、治疗持续时间和药物占有率来衡量。
LIS 双重队列的合并症明显高于非 LIS 比较组，LIS 非双重队列与非 LIS 接受者相比，所有 3 类药物的使用都明显更高，但差异较小（2%至 4%之间；P<0.05）。非 LIS 接受者和双重接受者接受任何抗糖尿病药物和抗高血脂药物的暴露情况相当，但与非 LIS 接受者相比，双重接受者接受肾素-血管紧张素-醛固酮系统抑制剂的可能性低 3%（P<0.05）。在 3 个队列中，调整后的治疗持续时间和药物占有率的数值差异较小，均无临床意义。
具有和不具有 LIS 覆盖的处方药计划参与者在药物使用方面的相似性支持了该计划的目标，即为不同的医疗保险受益人群提供更多获取所需药物的机会。
