Pharmacy Benefits and the Use of Drugs by the Chronically Ill

Abstract

is an employee and stock options holder of Merck. Dr Teutsch is an employee and stock options holder of Merck and a stockholder in Johnson & Johnson.

The Impact of the Medicare Part D Prescription Benefit on Generic Drug Use

“…First, although we used subjects' zip code-linked Census-level data and an out-of-pocket payout ratio to reflect the financial risk and generosity of drug plans, we were unable to identify subjects' individual-level socioeconomic characteristics or details of their benefit design (e.g., premiums, copayments, PDP vs. MAPD plan), and thus we could not adjust for these variables in our analyses. Such information would be of interest since the benefit design of the drug plans often affects prescription drug consumption 25 , and the impact of Part D enrollment on generic drug use may differ among subjects in PDPs vs. MAPDs. Future studies with greater details of patients' economic resources and drug plans may identify the degree to which Part D has had a differential impact for subjects based on their socioeconomic strata, economic incentives such as benefit design, and enrollment in PDPs vs. MAPDs.…”

“…We selected nine of these because they are among the most commonly used drug classes; together, they account for approximately half of all prescriptions dispensed annually in the United States based on nationally representative data for the entire US population 25 . Of these classes, our classification of ACE-inhibitors excluded angiotensin-receptor blockers and our classification of anti-ulcerants included both proton pump inhibitors as well as histamine-2 antagonists.…”

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

“…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.…”

Trends in Patient Cost Sharing for Clinical Services Used as Quality Indicators

“…First, when a generic option is not available in certain medication classes [e.g., inhaled corticosteroids for asthma, angiotensin II receptor blockers (ARBs) for congestive heart failure and diabetes] implementing a copayment increase for all brand name drugs without regard to availability of generic substitutes will result in decreased utilization within these high value classes. 4,5 When a generic agent is not available, benefit plans should set copayments for branded drugs in classes designated as quality indicators at a lower level than branded drugs in other classes.…”

“…3 Reviews of the available evidence conclude that when patients are required to pay a greater share of the cost, use of both essential and non-essential services are reduced. 4,5 Few data are available regarding how copayments have changed for specific services and whether changes differ by perceived level of clinical effectiveness. Accordingly, our aim is to describe the relative change in copayments for services commonly considered to be quality indicators as well as for interventions subject to programs to control utilization.…”