1 St. Louis College of Pharmacy, St. Louis, Missouri.
2 College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania.
J Manag Care Spec Pharm. 2017 Jan;23(1):5-12. doi: 10.18553/jmcp.2017.23.1.5.
Previous studies have shown that Medicare Part D was associated with a reduction in out-of-pocket expenditures for Medicare beneficiaries during the early years of its implementation (2006 and 2007). However, a question remains regarding the effect of Part D on out-of-pocket expenditures in the longer term.
To evaluate the effects of Part D on prescription drug expenditures and certain health care use for a longer time period using a large, nationally representative sample of Medicare beneficiaries.
Using Medical Expenditure Panel Survey (MEPS) data from 2000 through 2005 (pre-Part D period) and from 2007 through 2012 (Part D era), this study identified a cohort of elderly Medicare beneficiaries (treatment group) and a near-elderly non-Medicare population (control group). A difference-in-differences analysis was conducted to estimate the effect of Part D on prescription medication use and expenditures and outpatient visits. Propensity score weights and sampling weights were applied to obtain unbiased effect estimates accounting for complex survey designs.
A total of 26,585 elderly Medicare beneficiaries and 20,688 near-elderly non-Medicare beneficiaries were identified. The introduction of Part D was associated with an adjusted average reduction of $105 in annual out-of-pocket spending on prescription drugs during the post-Part D period (2007 through 2012). The reduction in annual out-of-pocket spending ranged from $49 to $152 during the post-Part D period. No significant increase was found in total prescription expenditures or prescription medication use following the introduction of Part D nor were there significant changes in outpatient visits.
A continued reduction of Part D out-of-pocket drug expenditures was found each year from 2007 to 2012.
No funding has been received to conduct this study or prepare this manuscript. The authors have no conflicts of interest to declare. Study concept and design were primarily contributed by Park with assistance from Jung. Both authors contributed equally to data analysis and interpretation. The manuscript was written primarily by Park, with assistance from Jung, and revised primarily by Jung.
先前的研究表明，在医疗保险处方药计划（Part D）实施的早期阶段（2006 年和 2007 年），该计划与医疗保险受益人的自付支出减少有关。然而，Part D 对长期自付支出的影响仍存在疑问。
使用大量具有全国代表性的医疗保险受益人群体，评估 Part D 对处方药支出和某些医疗保健使用的影响。
本研究使用 2000 年至 2005 年（Part D 前时期）和 2007 年至 2012 年（Part D 时期）的医疗支出调查（MEPS）数据，确定了一组老年医疗保险受益人群体（治疗组）和接近老年的非医疗保险人群（对照组）。采用差异中差异分析法估计 Part D 对处方药使用和支出以及门诊就诊的影响。应用倾向评分权重和抽样权重，以获得考虑复杂调查设计的无偏效应估计值。
共确定了 26585 名老年医疗保险受益人和 20688 名接近老年的非医疗保险受益人。Part D 的引入与 2007 年至 2012 年期间每年处方药自付支出的调整后平均减少 105 美元相关。2007 年至 2012 年期间，每年自付支出的减少幅度在 49 美元至 152 美元之间。在引入 Part D 后，总处方药支出或处方药使用并未显著增加，门诊就诊也未发生显著变化。
从 2007 年到 2012 年，每年都发现 Part D 自付药物支出持续减少。
进行这项研究或准备这份手稿没有得到任何资金支持。作者没有利益冲突需要申报。研究概念和设计主要由 Park 提出，并得到 Jung 的协助。两位作者都对等的贡献于数据分析和解释。初稿主要由 Park 撰写，得到 Jung 的协助，并由 Jung 主要修订。
