Blumberg Dana M, Prager Alisa J, Liebmann Jeffrey M
Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
Department of Ophthalmology, Columbia University Medical Center, College of Physicians and Surgeons, New York, New York.
JAMA Ophthalmol. 2016 Feb;134(2):212-20. doi: 10.1001/jamaophthalmol.2015.5090.
It is important to understand in more detail how patients with glaucoma were affected by the implementation of Medicare Part D, which was designed to provide beneficiaries with near-universal prescription drug coverage.
To determine changes in prescription drug coverage and out-of-pocket spending after the implementation of Medicare Part D across income strata and to identify characteristics of beneficiaries associated with prescription status.
DESIGN, SETTING, AND PARTICIPANTS: Longitudinal observational study in the general community using the Medicare Current Beneficiary Survey (pooled 2004, 2005, 2007, and 2008 data). Participants were noninstitutionalized Medicare beneficiaries who filled at least 1 glaucoma prescription during the survey years. The dates of this analysis were January 2004 to December 2009.
Effect of the implementation of the Medicare Part D drug benefit, including prescription drug coverage and risk-adjusted out-of-pocket spending related to glaucoma medications.
Respondents included 12,079 participants in the 2004 survey, 11,089 participants in the 2005 survey, 11,995 participants in the 2007 survey, and 11,723 participants in the 2008 survey. The sample included 19,045 glaucoma prescriptions, and 2519 Medicare beneficiaries filled at least 1 glaucoma prescription during the study years. Overall 574 (22.8%) beneficiaries reported living below the poverty level, and 795 (31.6%) had incomes consistent with near-poor status. The implementation of Medicare Part D resulted in increased rates of prescription drug coverage across all economic strata, with reductions in beneficiaries without coverage from 22.8% to 4.0%, 29.1% to 7.3%, and 19.9% to 3.7% among poor, near-poor, and higher-income beneficiaries, respectively. Despite these gains, near-poor status remained a risk factor for lack of prescription drug coverage after the implementation of Medicare Part D (odds ratio, 2.46; 95% CI, 1.26-4.55; P = .04). No differences were identified in adjusted out-of-pocket prescriptions drug costs between the near poor and those with higher income, although out-of-pocket costs were 37% (95% CI, 26%-49%; P < .001) lower among the poor relative to those with higher income.
Medicare Part D enrolled most beneficiaries with glaucoma who previously lacked prescription drug coverage. The results of this study suggest that coverage gains lagged among the near poor. While these data evaluated changes in coverage among cohorts of beneficiaries and not from longitudinal follow-up of patients, targeted efforts to improve prescription drug coverage among vulnerable beneficiaries would likely improve access to prescribed ocular hypotensive medications.
更详细地了解青光眼患者如何受到医疗保险D部分（旨在为受益人提供近乎普遍的处方药覆盖范围）实施的影响非常重要。
确定医疗保险D部分实施后不同收入阶层的处方药覆盖范围和自付费用变化，并确定与处方状态相关的受益人的特征。
设计、背景和参与者：使用医疗保险当前受益人调查（汇总2004年、2005年、2007年和2008年数据）在普通社区进行的纵向观察性研究。参与者是非机构化的医疗保险受益人，他们在调查年份至少开具了1份青光眼处方。本分析的日期为2004年1月至2009年12月。
医疗保险D部分药物福利实施的效果，包括处方药覆盖范围以及与青光眼药物相关的风险调整后的自付费用。
2004年调查中有12079名参与者，2005年调查中有11089名参与者，2007年调查中有11995名参与者，2008年调查中有11723名参与者。样本包括19045份青光眼处方，2519名医疗保险受益人在研究年份至少开具了1份青光眼处方。总体而言，574名（22.8%）受益人报告生活在贫困线以下，795名（31.6%）的收入与接近贫困状态相符。医疗保险D部分的实施导致所有经济阶层的处方药覆盖率提高，贫困、接近贫困和高收入受益人中无保险受益人的比例分别从22.8%降至4.0%、29.1%降至7.3%和19.9%降至3.7%。尽管有这些改善，但在医疗保险D部分实施后，接近贫困状态仍然是缺乏处方药覆盖的一个风险因素（优势比，2.46；95%置信区间为1.26 - 4.55；P = 0.04）。接近贫困者和高收入者在调整后的自付处方药费用方面没有差异，尽管贫困者的自付费用比高收入者低37%（95%置信区间为26% - 49%；P < 0.001）。
医疗保险D部分使大多数以前缺乏处方药覆盖的青光眼受益人参保。本研究结果表明，接近贫困者的覆盖改善滞后。虽然这些数据评估的是受益人群体之间的覆盖变化，而非患者的纵向随访情况，但有针对性地努力改善弱势受益人的处方药覆盖可能会改善获得处方降眼压药物的机会。
