Essentia Institute of Rural Health, Duluth, Minnesota.
Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Minnesota.
J Manag Care Spec Pharm. 2022 May;28(5):508-517. doi: 10.18553/jmcp.2022.28.5.508.
Cost-related nonadherence compromises successful and effective management of chronic disease. The Medicare Modernization Act of 2003 (MMA) and Patient Protection and Affordable Care Act of 2010 (ACA) aimed to increase the affordability of outpatient prescription drugs for older adults (older than age 64 years). The Medicare Part D prescription drug insurance coverage gap ("donut hole") created by the MMA was fully closed in 2020 by the ACA. To (1) describe prescription drug coverage and financial hardship from purchasing prescription drugs among older American adults for 2021, (2) compare these results with findings from data collected before the MMA and during the progressive elimination of the Medicare Part D coverage gap, and (3) compute the likelihood for financial hardship from purchasing prescription drugs using variables for year, prescription drug insurance coverage, health-related information, and demographics. Data were obtained from 4 nationally distributed, crosssectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs. Surveys in 1998 and 2001 were mailed to national random samples of US seniors. Of 2,434 deliverable surveys, 700 (29%) provided useable data. Data were collected in 2015 and 2021 via online surveys sent to samples of US adults. Of 27,694 usable responses, 4,445 were from older adults. Descriptive statistics and logistic regression analyses described relationships among financial hardship and demographics, diagnoses, and daily prescription drug use. Five percent of older adults lacked prescription drug coverage in 2021, continuing a downward trend from 32% in 1998, 29% in 2001, and 9% in 2015. Contrastingly, 20% of older adults reported financial hardship from prescription drug purchases in 2021, bending an upward trend from 19% in 1998, 31% in 2001, and 36% in 2015. Financial hardship from purchasing prescription drugs was more likely to be reported by older adults lacking prescription drug insurance, taking multiple medications daily, and having a low annual household income across all survey years. The latter 2 of these 3 factors were still predictive of financial hardship from purchasing prescription drugs among older adults with prescription drug insurance. Financial hardship from purchasing prescription drugs is still experienced by many older adults after the full implementation of the MMA and ACA. Lacking prescription drug coverage, taking more than 5 prescription drugs daily, and a low annual household income may increase the likelihood of experiencing this financial hardship. Pharmacists can be a resource for older adults making choices about their prescription drug coverages and purchases. Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, the Peters Endowment for Pharmacy Practice Innovation, the Chapman University Research Program, and the University Minnesota Research Program.
与慢性病成功和有效管理相关的费用问题导致很多患者无法遵医嘱用药。2003 年的《医疗保险现代化法案》（MMA）和 2010 年的《患者保护与平价医疗法案》（ACA）旨在提高老年人（64 岁以上）的门诊处方药的可负担性。MMA 创造的医疗保险部分 D 处方药保险覆盖范围缺口（“甜甜圈洞”）在 2020 年被 ACA 完全关闭。本研究旨在：(1) 描述 2021 年美国老年人的处方药覆盖范围和购买处方药的经济困难情况；(2) 将这些结果与 MMA 之前和医疗保险部分 D 覆盖范围逐渐消除期间收集的数据进行比较；(3) 使用年度、处方药保险覆盖范围、健康相关信息和人口统计学变量来计算购买处方药的经济困难可能性。研究数据来自于对老年人进行的 4 项全国性、横断面调查，以追踪处方药的覆盖范围和购买处方药的经济困难情况。1998 年和 2001 年的调查通过邮寄方式发送给美国老年人的全国随机样本。在可交付的 2434 份调查中，有 700 份（29%）提供了可用数据。2015 年和 2021 年的数据通过发送给美国成年人样本的在线调查收集。在 27694 份可用回复中，有 4445 份来自老年人。描述性统计和逻辑回归分析描述了经济困难与人口统计学、诊断和日常处方药使用之间的关系。2021 年，5%的老年人没有处方药覆盖范围，延续了自 1998 年的 32%、2001 年的 29%和 2015 年的 9%的下降趋势。相比之下，2021 年有 20%的老年人报告购买处方药存在经济困难，这一趋势呈上升趋势，1998 年为 19%，2001 年为 31%，2015 年为 36%。在所有调查年份中，没有处方药保险、每天服用多种药物和家庭年收入较低的老年人更有可能报告购买处方药存在经济困难。在有处方药保险的老年人中，后两个因素仍然可以预测购买处方药存在经济困难。在 MMA 和 ACA 全面实施后，许多老年人仍然面临购买处方药的经济困难。没有处方药覆盖范围、每天服用超过 5 种处方药和家庭年收入较低可能会增加经济困难的可能性。药剂师可以为选择处方药覆盖范围和购买处方药的老年人提供资源。研究资金由美国药学院新调查员计划、明尼苏达大学研究补助金计划、彼得斯药房实践创新捐赠、查普曼大学研究计划和明尼苏达大学研究计划提供。
