1 University of Minnesota College of Pharmacy, Minneapolis, Minnesota.
2 University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin.
J Manag Care Spec Pharm. 2016 Oct;22(10):1150-8. doi: 10.18553/jmcp.2016.22.10.1150.
The Medicare Modernization Act of 2003 (Medicare Part D) added prescription drug coverage for senior citizens aged 65 years and older and applied managed care approaches to contain costs. The Patient Protection and Affordable Care Act of 2010 (ACA) had the goals of expanding health care insurance coverage and slowing growth in health care expenditures.
To (a) describe the proportion of senior citizens who had prescription drug insurance coverage and the proportion who experienced financial hardship from purchasing medications in 2015, and (b) compare the findings with those collected in 1998 and 2001.
Data were obtained in 1998 and 2001 via surveys mailed to national random samples of seniors. Of 2,434 deliverable surveys, 946 (39%) were returned, and 700 (29%) provided usable data. Data were collected in 2015 via an online survey sent to a national sample of adults. Of 26,173 usable responses, 3,933 were aged 65 years or older. Descriptive statistics and logistic regression analyses described relationships among study variables.
Results showed that the proportion of seniors without prescription coverage was 9% in 2015, a decrease from 29% in 2001 and 32% in 1998. The proportion of senior citizens reporting financial hardship from medication purchases was 36% in 2015, a rise from 31% in 2001 and 19% in 1998. For those without prescription drug coverage, 34%, 55%, and 49% reported financial hardship in 1998, 2001, and 2015, respectively. For those with drug coverage, 12%, 22%, and 35% reported financial hardship in 1998, 2001, and 2015, respectively.
After implementation of Medicare Part D and the ACA, the proportion of seniors without prescription drug coverage decreased. However, self-reported financial hardship from purchasing medications increased. Senior citizens with prescription drug insurance may be experiencing financial hardship from increasing out-of-pocket costs for insurance premiums, cost sharing, and full-cost obligation for some medications.
Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, and the Peters Endowment for Pharmacy Practice Innovation. The authors have no conflicts of interest to declare. Schommer, Mott, and Brown contributed to study design and collected the data, with assistance from Olson. Data interpretation was performed by Olson, Schommer, Mott, and Brown. The manuscript was written and revised by Olson, Schommer, Mott, and Brown.
2003 年的《医疗保险现代化法案》（医疗保险部分 D）为 65 岁及以上的老年人增加了处方药保险，并采用了管理式医疗方法来控制成本。2010 年的《患者保护与平价医疗法案》（ACA）的目标是扩大医疗保险覆盖范围并减缓医疗保健支出的增长。
（a）描述 2015 年有处方药保险的老年人比例以及购买药物有经济困难的老年人比例；（b）将这些发现与 1998 年和 2001 年的调查结果进行比较。
1998 年和 2001 年的数据通过邮寄给全国老年人随机样本的调查收集。在可交付的 2434 份调查中，有 946 份（39%）被退回，其中 700 份（29%）提供了可用数据。2015 年的数据通过向全国成年人的在线调查收集。在 26173 份可用回复中，有 3933 份年龄在 65 岁或以上。描述性统计和逻辑回归分析描述了研究变量之间的关系。
结果显示，2015 年没有处方药保险的老年人比例为 9%，低于 2001 年的 29%和 1998 年的 32%。报告购买药物有经济困难的老年人比例为 36%，高于 2001 年的 31%和 1998 年的 19%。对于没有处方药保险的老年人，分别有 34%、55%和 49%在 1998 年、2001 年和 2015 年报告有经济困难。对于有药物保险的老年人，分别有 12%、22%和 35%在 1998 年、2001 年和 2015 年报告有经济困难。
在医疗保险部分 D 和 ACA 实施后，没有处方药保险的老年人比例下降。然而，自报购买药物有经济困难的比例增加。有处方药保险的老年人可能因保险费、共同支付和某些药物的全额自付费用的自付额增加而面临经济困难。
本研究由美国药学院协会新研究员计划、明尼苏达大学研究补助金计划和彼得斯药房实践创新捐赠基金提供资金。作者没有利益冲突需要声明。Schommer、Mott 和 Brown 参与了研究设计和数据收集，并得到了 Olson 的协助。Olson、Schommer、Mott 和 Brown 对数据进行了解释。Olson、Schommer、Mott 和 Brown 撰写并修订了手稿。
