Employer Drug Benefit Plans and Spending on Prescription Drugs

Joyce, Geoffrey F.; Escarce, José J.; Solomon, Matthew D.; Goldman, Dana P.

doi:10.1001/jama.288.14.1733

Cited by 180 publications

(163 citation statements)

References 28 publications

(24 reference statements)

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“…Further, clinician prescribing behavior may reflect differences in patient preferences or formulary structure in health plan prescription drug coverage. 36,37 Additional qualitative and quantitative research to better understand the causes and potential adverse consequences of this variation is warranted.…”

Section: Commentsmentioning

confidence: 99%

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

Qato

Trivedi

2012

J GEN INTERN MED

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In fully adjusted models, females had a 10.6 (95 % CI: 10.0-11.2) higher percentage point rate of receipt than males, and residence in any of the Southern United States divisions was associated with a greater than 10 percentage point higher rate, as compared with the reference New England division. Higher rates were also observed among enrollees with low personal income (6.5 percentage points, 95 % CI: 5.5-7.5), relative to those without low income and those residing in areas in the lowest quintile of socioeconomic status (2.7 points, 95 % CI: 1.9-3.4) relative to persons residing in the highest quintile. Enrollees ≥ 85 years old, black enrollees, and other minority groups were less likely to receive these medications. Over 38 % of MA enrollees residing in the hospital referral region of Albany, Georgia received at least one HRM, a rate four times higher than the referral region with the lowest rate (Mason City, Iowa). CONCLUSIONS: Use of HRMs among MA enrollees varies widely by geographic region. Persons living in the Southern region of the U.S., whites, women, and persons of low personal income and socioeconomic status are more likely to receive HRMs.

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Section: Commentsmentioning

confidence: 99%

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

Qato

Trivedi

2012

J GEN INTERN MED

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“…As a form of cost sharing, the gap could induce cost-related medication nonadherence (CRN), adversely affecting health status, particularly among individuals with chronic conditions. [1][2][3][4][5][6][7][8][9][10][11][12][13] The introduction of the Part D program led to higher medication use rates among seniors, with recent studies indicating that other healthcare service use reductions partly offset program costs. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Most Part D enrollees' expenditures do not reach the gap threshold: 12 % of enrollees, and 19 % of those who filled at least one prescription, reached the gap in 2009, lower proportions than in previous years.…”

Section: Introductionmentioning

confidence: 99%

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

et al. 2013

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BACKGROUND:Although the Medicare Part D coverage gap phase-out should reduce cost-related nonadherence (CRN) among seniors with diabetes, preferential generic prescribing may have already decreased CRN, while smaller numbers of patients using more costly branded oral antidiabetic (OAD) medications remain vulnerable to CRN. OBJECTIVE: To estimate the effects of cost sharing in the Part D standard (non-LIS) benefit on adherence to different OAD classes, comparing two classes dominated by inexpensive generic medications and two by more costly branded medications. DESIGN AND PATIENTS: Retrospective cohort study using dispensed prescription data for elderly non-LIS (N= 81,047) and LIS (low-income subsidy) (N=150,359) beneficiaries using same class OAD(s) in 2008 and 2009. Logistic regression modeled non-LIS likelihood; LIS and non-LIS patients matched using propensity outcome (N= 38,054). Logistic regression, controlling for demographic and health status characteristics, modeled effects of non-LIS coverage on 2009 OAD class adherence. MAIN MEASURES: Main outcome measures were within-class OAD coverage year adherence, with patients considered adherent when days supplied to calendar days ratio at least 0.8. KEY RESULTS: Non-LIS patients had 0.52 and 0.57 times the odds of branded-only DPP-4 Inhibitor (N= 1,812; 95 % CI: 0.43, 0.63; P<0.001) and Thiazolidinedione (TZD) (N=6,290; 95 % CI: 0.52, 0.63; P<0.001) adherence. Most patients (N=32,510; 82 %) used OADs in primarily generic classes, where we found no significant (Biguanides; N=21,377) or small differences (Sulfonylureas/Glinides [N=19,240; OR: 0.91; 95 % CI: 0.86, 0.97; P =0.002]) in adherence odds. Crude adherence rates were sub-optimal when CRN was not a factor (Non-LIS/LIS: Biguanides: 65 %/65 %; Sulfonylureas/Glinides: 66 %/ 68 %; LIS: DPP-4 Inhibitors: 66 %; TZDs: 67 %). CONCLUSIONS: Gap elimination would not affect generic, but should reduce branded OAD CRN. Branded copayments may continue to lead to CRN. Policy initiatives and benefit changes targeting both cost deterrents for patients with more complex disease and non-cost generic OAD underuse are recommended.

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“…Furthermore, there has been an increase in the number of diseases treated with multiple drug therapies, and, as a result of improved medical technology, life expectancy is being extended, allowing patients to utilize medications for longer periods of time. 5,6 Many other factors, including direct-to-consumer advertising, can also be associated with an increase in prescription drug ABSTRACT BACKGROUND: Health plans are using 3-tier copayment designs and other methods to control utilization that shifts drug costs to plan members. There is a need to determine the effects of increased member cost sharing on drug utilization and drug costs.…”

mentioning

confidence: 99%

“…Joyce et al 6 studied the impact of an increased prescription copayment within multiple formulary designs (1-tier, 2-tier, and 3-tier) using claims from a working population and its beneficiaries aged 18 to 64 years. A 2-part probit model was used to examine the impact on the provider and patients.…”

mentioning

confidence: 99%

Effects of an Increase in Prescription Copayment on Utilization of Low-Sedating Antihistamines and Nasal Steroids

Meissner

Moore²,

Shinogle³

et al. 2004

JMCP

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ealth care administrators are struggling to provide quality care while controlling costs. New advancements in the treatment of highly prevalent diseases contributed to the $1.2 trillion spent on health care in the United States in 1999.1 Moreover, during 1999, the growth in prescription drug expenditure led all other health care services, at 16.9%.1 The Centers for Medicare & Medicaid Studies (CMS) projected that by 2010, health care expenditure will total $2.6 trillion and account for 15.9% of the gross domestic product. 2These increases are fueled in part by the rising drug cost and increased utilization of pharmaceuticals. 1,2The increase in pharmacy expenditure can be attributed to a number of factors. For instance, over the past 30 years, the number of third parties expanding prescription benefits has increased, as evidenced by the decrease in the average percentage of prescription costs paid out-of-pocket by the consumer. Based on national estimates from CMS, 96.2% of medication costs were paid out-of-pocket (cash purchases) by consumers in 1960 compared with 26.6% in 1998. 3 Expanding coverage of prescription drugs lowers the effective price to the patient and may lead to increased utilization. 4 Also, as medical knowledge grows, newer, more expensive pharmaceutical agents are becoming the "standard of care" for more illnesses. Furthermore, there has been an increase in the number of diseases treated with multiple drug therapies, and, as a result of improved medical technology, life expectancy is being extended, allowing patients to utilize medications for longer periods of time. 5,6 Many other factors, including direct-to-consumer advertising, can also be associated with an increase in prescription drug ABSTRACT BACKGROUND: Health plans are using 3-tier copayment designs and other methods to control utilization that shifts drug costs to plan members. There is a need to determine the effects of increased member cost sharing on drug utilization and drug costs.

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Employer Drug Benefit Plans and Spending on Prescription Drugs

Cited by 180 publications

References 28 publications

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

Effects of an Increase in Prescription Copayment on Utilization of Low-Sedating Antihistamines and Nasal Steroids

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