Chou Joshua, Brandt Nicole J, Loh F Ellen, Stuart Bruce
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Consult Pharm. 2017 Feb 1;32(2):109-118. doi: 10.4140/TCP.n.2017.109.
The objective of this study was to describe the type of restrictions and differences among antipsychotic users enrolled in Medicare Part D Stand-Alone (PDPs) and Advantage (MAPDs) prescription drug plans.
This retrospective study used data from Chronic Condition Data Warehouse, comprising a random 5% sample of the Medicare population in 2008. This study used bivariate analyses and multivariate logistical regression models to study differences in formulary restrictions on antipsychotic use between PDP and MAPD enrollees, adjusting for enrollee characteristics. Dependent variables included type of restriction and antipsychotic therapeutic class. The study sample was restricted to continuous Part D enrollees (N = 1,346,978) stratified by plan type, MAPDs (N = 435,591), and PDPs (N = 911,387).
According to the bivariate analysis, antipsychotic users enrolled in PDPs were more likely to encounter restrictions (39.8%), compared with those in MAPDs (30.3%). In the multivariate analyses, antipsychotic users in MAPDs were less likely to face any restriction (odds ratio [OR] = 0.75, 95% confidence interval [CI] 0.72-0.78). Furthermore, atypical antipsychotic users in MAPDs were less likely to face any restriction (OR = 0.76, 95% CI 0.73-0.79), while first-generation antipsychotic users in MAPDs were more likely to face any restriction (OR = 1.87, 95% CI 1.32-2.65). Low-income subsidy (LIS) beneficiaries using any antipsychotic were much more likely to face restrictions compared with non-LIS beneficiaries.
PDP enrollees prescribed antipsychotics were more likely to face formulary restrictions, as opposed to those in MAPDs. LIS beneficiaries enrolled in PDPs faced much higher risk of restricted access to this "protected" drug class.
本研究的目的是描述参加医疗保险D部分独立处方药计划（PDP）和优势处方药计划（MAPD）的抗精神病药物使用者所面临的限制类型及差异。
这项回顾性研究使用了慢性病数据仓库中的数据，该数据包含2008年医疗保险人群5%的随机样本。本研究采用双变量分析和多变量逻辑回归模型，在调整参保人特征的情况下，研究PDP和MAPD参保人在抗精神病药物使用的处方限制方面的差异。因变量包括限制类型和抗精神病药物治疗类别。研究样本限于按计划类型分层的连续D部分参保人（N = 1,346,978），其中MAPD参保人（N = 435,591），PDP参保人（N = 911,387）。
根据双变量分析，参加PDP的抗精神病药物使用者比参加MAPD的使用者更有可能遇到限制（39.8%对30.3%）。在多变量分析中，参加MAPD的抗精神病药物使用者面临任何限制的可能性较小（优势比[OR]=0.75，95%置信区间[CI]0.72 - 0.78）。此外，参加MAPD的非典型抗精神病药物使用者面临任何限制的可能性较小（OR = 0.76，95%CI 0.73 - 0.79），而参加MAPD的第一代抗精神病药物使用者面临任何限制的可能性较大（OR = 1.87，95%CI 1.32 - 2.65）。与非低收入补贴（LIS）受益人相比，使用任何抗精神病药物的LIS受益人面临限制的可能性要大得多。
与参加MAPD的人相比，开了抗精神病药物的PDP参保人更有可能面临处方限制。参加PDP的LIS受益人在获取这类“受保护”药物方面面临的受限风险要高得多。
