医药补助计划中接近贫困的老年患者的经济负担和药物依从性。
Financial burden and medication adherence among near-poor older adults in a pharmaceutical assistance program.
机构信息
University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
Texas A&M University, Bush School of Government and Public Service, 4220 TAMU, College Station, TX, 77843, USA.
出版信息
Res Social Adm Pharm. 2022 Mar;18(3):2517-2523. doi: 10.1016/j.sapharm.2021.04.016. Epub 2021 Apr 29.
BACKGROUND
With increasing drug prices in the past decade, affordability and medication adherence are a growing concern for near-poor older adults, especially for those who are not receiving Low-Income Subsidy in Medicare Part D. SeniorCare is a pharmaceutical assistance program in Wisconsin for near-poor older adults, providing comprehensive prescription coverage with flat copayments.
OBJECTIVES
To evaluate five-year trends in financial hardship and medication adherence and to examine factors associated with these outcomes in SeniorCare members.
METHODS
SeniorCare program enrollment and pharmacy claims data from 2014 to 2018 were used. The study population was near-poor older adults in SeniorCare with annual family income ≤200% of the federal poverty level. Financial burden was assessed using the proportion of total annual out-of-pocket costs to total annual income. Medication adherence was assessed by adapting the measures endorsed by the Pharmacy Quality Alliance and National Quality Forum. Descriptive statistics and independent t-tests were used to evaluate the trends, and multivariate logistic regressions were conducted to examine factors associated with financial burden and medication adherence.
RESULTS
From 2014 to 2018, mean annual out-of-pocket costs per member declined by 3.7% (p < 0.001) for all drugs, while those for specialty drugs increased by 31.2% (p < 0.05). Around 3.3% spent more than 5% of their income for prescription drugs in 2014, which decreased to 2.4% in 2018 (p < 0.001). The proportions of adherent patients increased from 78.1% to 81.2% (p < 0.001) for diabetes medications (excluding insulins), from 77.3% to 79.5% (p < 0.001) for statins, and from 79.8% to 80.8% (p < 0.05) for RASA. Members subject to a $500 annual deductible were more likely to experience high financial burden (adjusted odds ratio (AOR) = 1.677, p < 0.001) and less likely to be adherent to diabetes medications (AOR = 0.484, p < 0.001).
CONCLUSIONS
The near-poor older adults enrolled in Wisconsin SeniorCare program had low financial burden and good medication adherence within the program.
背景
在过去十年中，药品价格不断上涨，对于接近贫困的老年人来说，药物的可负担性和用药依从性是一个日益严重的问题，尤其是对于那些没有参加医疗保险处方药部分的低收入补贴的人来说。威斯康星州的 SeniorCare 是一个面向接近贫困的老年人的药品援助项目，提供全面的处方保险，费用固定。
目的
评估 SeniorCare 参保者在五年内经济困难和用药依从性的趋势，并研究影响这些结果的因素。
方法
使用了 2014 年至 2018 年的 SeniorCare 项目登记和药房理赔数据。研究人群是 SeniorCare 中年收入低于联邦贫困线 200%的接近贫困的老年人。通过将年度自付费用占总收入的比例来评估经济负担。用药依从性通过调整药房质量联盟和国家质量论坛认可的措施来评估。使用描述性统计和独立 t 检验评估趋势，使用多变量逻辑回归分析与经济负担和用药依从性相关的因素。
结果
2014 年至 2018 年，所有药物的每位成员的年度自付费用中位数每年下降 3.7%（p<0.001），而专科药物的自付费用中位数每年增长 31.2%（p<0.05）。约有 3.3%的人在 2014 年用于处方药的支出超过了其收入的 5%，这一比例在 2018 年降至 2.4%（p<0.001）。糖尿病药物（不包括胰岛素）的依从性患者比例从 78.1%增加到 81.2%（p<0.001），他汀类药物的依从性患者比例从 77.3%增加到 79.5%（p<0.001），RASA 的依从性患者比例从 79.8%增加到 80.8%（p<0.05）。对于有 500 美元年度免赔额的成员，他们更有可能经历高经济负担（调整后的优势比（AOR）=1.677，p<0.001），并且不太可能依从糖尿病药物（AOR=0.484，p<0.001）。
结论
参加威斯康星州 SeniorCare 计划的接近贫困的老年人经济负担低，用药依从性好。
Zotero 插件