Stuart Bruce, Hendrick Franklin B, Xu Jing, Dougherty J Samantha
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.
Doctoral Program in Gerontology, University of Maryland Baltimore County, Baltimore, MD.
Health Serv Res. 2017 Jun;52(3):1185-1206. doi: 10.1111/1475-6773.12520. Epub 2016 Jun 20.
To determine the magnitude and mechanisms of response to Medicare Part D cost sharing by low-income subsidy (LIS) recipients using oral hypoglycemic agents (OHAs) and statins.
Medicare data for a 5 percent random sample of beneficiaries with diabetes enrolled in fee-for-service Part D drug plans in 2008.
We evaluated the impact of differences between generic and brand cost sharing rates among cohorts of LIS and non-LIS recipients to determine if wider price spreads increased the generic dispensing rate (GDR) and reduced total drug use and cost.
We found little association between cost sharing and aggregate OHA and statin use. In adjusted analyses, non-LIS beneficiaries who paid 46 percent of total OHA costs had 2.5 percent fewer OHA days supply than full benefit dual eligibles who paid just 5 percent of their therapy costs. For statins, the difference in days supply between those facing the lowest and highest cost sharing was 4.6 percent. Higher cost sharing was associated with filling fewer but larger prescriptions for both generics and brands.
Higher generic and brand copays had little association with OHA and statin use among LIS recipients. This implies that modest changes in required cost sharing for these medicines would have very little substantive impact on generic dispensing or utilization patterns among LIS recipients and thus would have little effect on total program spending. At the same time, any increases in out-of-pocket costs would be expected to shift costs and place greater financial burden on low-income beneficiaries, particularly those in poor health.
确定使用口服降糖药（OHA）和他汀类药物的低收入补贴（LIS）接受者对医疗保险D部分费用分摊的反应程度和机制。
2008年参加按服务收费的D部分药物计划的糖尿病受益人的5%随机样本的医疗保险数据。
我们评估了LIS和非LIS接受者队列中通用名药和品牌药费用分摊率差异的影响，以确定更大的价格差是否会提高通用名药配药率（GDR）并减少总药物使用和成本。
我们发现费用分摊与OHA和他汀类药物的总体使用之间几乎没有关联。在调整分析中，支付OHA总费用46%的非LIS受益人比仅支付治疗费用5%的全额受益双重资格者的OHA日供应量少2.5%。对于他汀类药物，面临最低和最高费用分摊的人群之间的日供应量差异为4.6%。更高的费用分摊与通用名药和品牌药的处方填充量减少但处方量更大有关。
更高的通用名药和品牌药自付费用与LIS接受者的OHA和他汀类药物使用几乎没有关联。这意味着这些药物所需费用分摊的适度变化对LIS接受者的通用名药配药或使用模式几乎没有实质性影响，因此对总计划支出影响不大。与此同时，预计自付费用的任何增加都会转移成本并给低收入受益人，特别是健康状况不佳的受益人带来更大的经济负担。
