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Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap
BACKGROUND: Nations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the “cover...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156689/ https://www.ncbi.nlm.nih.gov/pubmed/21857811 http://dx.doi.org/10.1371/journal.pmed.1001075 |
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author | Polinski, Jennifer M. Shrank, William H. Huskamp, Haiden A. Glynn, Robert J. Liberman, Joshua N. Schneeweiss, Sebastian |
author_facet | Polinski, Jennifer M. Shrank, William H. Huskamp, Haiden A. Glynn, Robert J. Liberman, Joshua N. Schneeweiss, Sebastian |
author_sort | Polinski, Jennifer M. |
collection | PubMed |
description | BACKGROUND: Nations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the “coverage gap” during which beneficiaries are fully responsible for drug costs. We examined the impact of entering the coverage gap on drug discontinuation, switching to another drug for the same indication, and drug adherence. While increased discontinuation of and adherence to essential medications is a regrettable response, increased switching to less expensive but therapeutically interchangeable medications is a positive response to minimize costs. METHODS AND FINDINGS: We followed 663,850 Medicare beneficiaries enrolled in Part D or retiree drug plans with prescription and health claims in 2006 and/or 2007 to determine who reached the gap spending threshold, n = 217,131 (33%). In multivariate Cox proportional hazards models, we compared drug discontinuation and switching rates in selected drug classes after reaching the threshold between all 1,993 who had no financial assistance during the coverage gap (exposed) versus 9,965 multivariate propensity score-matched comparators with financial assistance (unexposed). Multivariate logistic regressions compared drug adherence (≤80% versus >80% of days covered). Beneficiaries reached the gap spending threshold on average 222 d ±79. At the drug level, exposed beneficiaries were twice as likely to discontinue (hazard ratio [HR] = 2.00, 95% confidence interval [CI] 1.64–2.43) but less likely to switch a drug (HR = 0.60, 0.46–0.78) after reaching the threshold. Gap-exposed beneficiaries were slightly more likely to have reduced adherence (OR = 1.07, 0.98–1.18). CONCLUSIONS: A lack of financial assistance after reaching the gap spending threshold was associated with a doubling in discontinuing essential medications but not switching drugs in 2006 and 2007. Blunt cost-containment features such as the coverage gap have an adverse impact on drug utilization that may conceivably affect health outcomes. Please see later in the article for the Editors' Summary |
format | Online Article Text |
id | pubmed-3156689 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-31566892011-08-19 Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap Polinski, Jennifer M. Shrank, William H. Huskamp, Haiden A. Glynn, Robert J. Liberman, Joshua N. Schneeweiss, Sebastian PLoS Med Research Article BACKGROUND: Nations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the “coverage gap” during which beneficiaries are fully responsible for drug costs. We examined the impact of entering the coverage gap on drug discontinuation, switching to another drug for the same indication, and drug adherence. While increased discontinuation of and adherence to essential medications is a regrettable response, increased switching to less expensive but therapeutically interchangeable medications is a positive response to minimize costs. METHODS AND FINDINGS: We followed 663,850 Medicare beneficiaries enrolled in Part D or retiree drug plans with prescription and health claims in 2006 and/or 2007 to determine who reached the gap spending threshold, n = 217,131 (33%). In multivariate Cox proportional hazards models, we compared drug discontinuation and switching rates in selected drug classes after reaching the threshold between all 1,993 who had no financial assistance during the coverage gap (exposed) versus 9,965 multivariate propensity score-matched comparators with financial assistance (unexposed). Multivariate logistic regressions compared drug adherence (≤80% versus >80% of days covered). Beneficiaries reached the gap spending threshold on average 222 d ±79. At the drug level, exposed beneficiaries were twice as likely to discontinue (hazard ratio [HR] = 2.00, 95% confidence interval [CI] 1.64–2.43) but less likely to switch a drug (HR = 0.60, 0.46–0.78) after reaching the threshold. Gap-exposed beneficiaries were slightly more likely to have reduced adherence (OR = 1.07, 0.98–1.18). CONCLUSIONS: A lack of financial assistance after reaching the gap spending threshold was associated with a doubling in discontinuing essential medications but not switching drugs in 2006 and 2007. Blunt cost-containment features such as the coverage gap have an adverse impact on drug utilization that may conceivably affect health outcomes. Please see later in the article for the Editors' Summary Public Library of Science 2011-08-16 /pmc/articles/PMC3156689/ /pubmed/21857811 http://dx.doi.org/10.1371/journal.pmed.1001075 Text en Polinski et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Polinski, Jennifer M. Shrank, William H. Huskamp, Haiden A. Glynn, Robert J. Liberman, Joshua N. Schneeweiss, Sebastian Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap |
title | Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap |
title_full | Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap |
title_fullStr | Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap |
title_full_unstemmed | Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap |
title_short | Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap |
title_sort | changes in drug utilization during a gap in insurance coverage: an examination of the medicare part d coverage gap |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156689/ https://www.ncbi.nlm.nih.gov/pubmed/21857811 http://dx.doi.org/10.1371/journal.pmed.1001075 |
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