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首页> 外文期刊>Journal of general internal medicine >Drug benefit changes under medicare advantage part D: heterogeneous effects on pharmaceutical use and expenditures.
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Drug benefit changes under medicare advantage part D: heterogeneous effects on pharmaceutical use and expenditures.

机译：医疗保险利益D部分下的药物利益变化：对药物使用和支出的异质影响。

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BACKGROUND: Although Medicare Part D improved drug benefits for many beneficiaries, its impact on the coverage of Medicare Advantage Part D (MAPD) enrollees depended on their pre-existing benefits and whether they had gap coverage under Part D. OBJECTIVE: To examine changes in prescription drug utilization and expenditures associated with drug benefit changes resulting from the implementation of Part D. PATIENTS: We studied 248,773 continuously enrolled MAPD patients in eight states. Patients whose insurance product or Census block could not be identified or who had atypical benefits, low-income subsidies or Medicaid coverage were excluded. MAIN MEASURES: The main outcomes were changes in prescription drug days supply and expenditures from 2005 to 2006 and 2005 to 2007. DESIGN: We linked Census data with 2005-7 MAPD claims, encounter, enrollment, and benefits data and estimated associations of the outcomes with changes in drug benefits, controlling for 2005 comorbidities, demographics, and Census population characteristics. KEY RESULTS: MAPD enrollees whose drug benefits became potentially less generous after Part D had the smallest increases in drug utilization and expenditures (e.g., drug expenditures increased by Dollars 130 between 2005 and 2006), while those who potentially gained the most from Part D experienced the largest increases (Dollars 302). The differences in benefit design changes had a stronger association with drug utilization and outcomes among patients at high risk of gap entry than among the entire sample. CONCLUSIONS: Although Medicare Part D unambiguously improved drug coverage for many elderly, it led to heterogeneous changes in drug benefits among MAPD enrollees, who already had generic and sometimes branded drug benefits. After 2006, benefits were worse for individuals who had branded drug coverage in 2005 but now had a coverage gap, but benefits may have improved for individuals who acquired branded drug coverage. Commensurate with these differential changes in benefits following Part D, changes in drug utilization and expenditures varied substantially as well.
机译：背景：尽管Medicare D部分为许多受益人改善了药品福利，但其对Medicare Advantage D部分（MAPD）参保人覆盖范围的影响取决于他们先前已有的福利以及他们是否在D部分之下有缺口覆盖。目的：研究以下方面的变化：处方药的使用和与实施D部分导致的药物受益变更相关的支出。患者：我们研究了八个州的248,773名MAPD连续入组患者。无法确定其保险产品或人口普查封锁或具有非典型福利，低收入补贴或医疗补助的患者。主要指标：主要结果是2005年至2006年以及2005年至2007年处方药日的供求关系变化。设计：我们将普查数据与2005-7 MAPD索赔，相遇，入院和受益数据以及结果的估计关联起来药物收益的变化，控制2005年合并症，人口统计学和人口普查特征。关键结果：MAPD参与者在D部分的药物利用和支出增幅最小之后（例如2005年至2006年间，药物支出增加了130美元），其药物收益可能变得不那么慷慨，而那些从D部分获得最多收益的人群则经历了增长幅度最大（美元302）。受益设计变更的差异与存在缺口的高风险患者相比，与整个样本之间的药物利用和结局关系更强。结论：尽管Medicare D部分明确地改善了许多老年人的药物覆盖率，但它导致MAPD参保者的药物获益发生了异质性变化，他们已经具有通用药物治疗，有时还具有品牌药物益处。 2006年之后，对于在2005年拥有品牌药物覆盖范围但现在存在覆盖范围缺口的个人，福利会更差，但是对于获得品牌药物覆盖范围的人员，福利可能有所改善。与D部分之后收益的这些差异性变化相对应，药物利用和支出的变化也大不相同。

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