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Topics in Medicare Prescription Drug Enrollment in the Low-Income Subsidy Population.

機譯：低收入補貼人群中的Medicare處方藥注冊主題。

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In Medicare Part D, random assignment and potential yearly reassignment to premium-free stand-alone prescription drug plans (PDPs) is the default plan enrollment option for low-income subsidy (LIS) recipients. Randomization can cause medication access issues, but the impacts on medication use remain unclear because those who choose plans have not been separately examined. Medicare Advantage prescription drug plans (MAPDs) and tailored dual eligible Special Needs Plans (D-SNPs) have financial incentives to improve the medication adherence of Medicare-Medicaid dual eligibles compared to Medicare fee-for-service (FFS), but this relationship has not been assessed.;The study used 2006-2009 Medicare administrative data and a customized dataset that differentiated plan election types.;In aim 1, 29,784 LIS recipients assigned in 2007 were followed for three years and only 26% became choosers, with half selecting MA plans. PDP choosers appeared sicker and had higher Part D costs than non-choosers. In contrast, MA enrollees had fewer chronic conditions and lower costs than non-choosers. Choosers' plans covered more drugs than non-choosers' plans.;In aim 2, medication use and costs were compared among 28,610 statin users who either accepted or opted out of reassignment. Cross-sectional and difference-in-differences (DID) regression models examined changes in statin use and costs. Compared to reassignees, the 7.6% who opted out were less likely to discontinue (-0.8%) and switch statins (-7.0%) and exhibited relative increases over time in brand name use (6.8%) and 30-day fill costs to Medicare (;In aim 3, drug adherence with statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) was compared for samples of dual eligibles enrolled in FFS, MAPDs, and D-SNPs over 24 months, including subsamples who switched from FFS to managed care. Analyses included cross-sectional and DID regressions. Drug adherence was slightly higher among managed care dual eligibles when compared to FFS dual eligibles, but a percentage of those switching from FFS experienced disruptions in use.;In conclusion, few randomized LIS recipients choose their own plans. Opting out of reassignment has minimal impact on statin adherence and costs. Additional safeguard policies are needed for dual eligibles switching from FFS to Medicare managed care.
機譯：在Medicare D部分中，對低收入補貼（LIS）接收者的默認計劃注冊選項是對免費保費獨立處方藥計劃（PDP）的隨機分配和潛在的年度重新分配。隨機化可能會導(dǎo)致藥物使用問題，但對藥物使用的影響尚不清楚，因為選擇計劃的人尚未單獨檢查。與Medicare收費服務(wù)（FFS）相比，Medicare Advantage處方藥計劃（MAPD）和量身定制的雙重合格特殊需求計劃（D-SNP）具有經(jīng)濟上的誘因，可以提高Medicare-Medicaid雙重合格者的藥物依從性。該研究使用了2006-2009年Medicare行政數(shù)據(jù)和一個定制的數(shù)據(jù)集來區(qū)分計劃的選舉類型。在目標1中，對2007年分配的29,784名LIS接受者進行了三年跟蹤，只有26％的選擇者成為了選擇者，一半的選擇者MA計劃。與非選擇者相比，PDP選擇者顯得病態(tài)且D部分的費用更高。相反，與非選擇者相比，MA參與者的慢性病更少，成本更低。選擇者的計劃比非選擇者的計劃覆蓋更多的藥物。在目標2中，比較了接受或選擇退出重新分配的28,610個他汀類藥物使用者的藥物使用和費用。橫斷面和差異差異（DID）回歸模型檢查了他汀類藥物使用和成本的變化。與重新分配的人員相比，退出的7.6％接受停藥（-0.8％）和轉(zhuǎn)換他汀類藥物（-7.0％）的可能性較小，并且隨著時間的推移，使用名牌藥物（6.8％）和30天醫(yī)療保險費用的相對增加（;在目標3中，比較了在24個月內(nèi)參加FFS，MAPD和D-SNP的雙重合格樣本中他汀類藥物和血管緊張素轉(zhuǎn)換酶抑制劑/血管緊張素受體阻滯劑（ACEIs / ARBs）的藥物依從性，包括轉(zhuǎn)換后的子樣本從FFS到有管理的護理。分析包括橫斷面和DID回歸。與FFS有雙重資格的人相比，有管理有雙重資格的人的藥物依從性稍高，但是從FFS轉(zhuǎn)換為有服務(wù)的人的使用受到干擾。 LIS隨機接受者選擇自己的計劃，退出重新分配對他汀類藥物依從性和費用的影響最小，雙重合格人員從FFS轉(zhuǎn)向Medicare管理的護理需要額外的保障政策。

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  • 作者單位

    University of Maryland, Baltimore.;

  • 授予單位 University of Maryland, Baltimore.;
  • 學科 Pharmaceutical sciences.
  • 學位 Ph.D.
  • 年度 2016
  • 頁碼 143 p.
  • 總頁數(shù) 143
  • 原文格式 PDF
  • 正文語種 eng
  • 中圖分類 地球物理學;
  • 關(guān)鍵詞

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