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2017-04-09 发布于江苏
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Pharmacy Benefits and the Use of Drugs by the Chronically Ill.pdf

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Pharmacy Benefits and the Use of Drugs by the Chronically Ill

ORIGINAL CONTRIBUTION Pharmacy Benefits and the Use of Drugs by the Chronically Ill Dana P. Goldman, PhD Geoffrey F. Joyce, PhD Jose J. Escarce, MD, PhD Jennifer E. Pace, BS Matthew D. Solomon, MA Marianne Laouri, PhD Pamela B. Landsman, MPH, DrPH Steven M. Teutsch, MD, MPH IN RECENT YEARS, MANY HEALTHplans have implemented policies tocontain drugs costs, including rais-ing beneficiary co-payments, man- dating use of generics, requiring mail- order services, and expanding use of formularies, all of which have large ef- fects on total drug spending. For ex- ample, doubling co-payments re- duced total drug spending by 19% to 33% in one multiyear study of 25 com- panies.1 Such large responses often raise concerns about adverse health conse- quences, particularly for chronically ill individuals. Indeed, large changes in drug benefits are sometimes associ- ated with substantial morbidity and mortality in certain high-risk popula- tions.2-4 In the privately insured nonelderly population, the patterns may differ. Al- though there is also evidence that this population changes its patterns of drug use when benefits change, there is less evidence of adverse health conse- quences. One plausible explanation is that the health consequences manifest over many years, and relevant longitu- dinal databases are scarce. In addi- tion, there may be different responses, depending on the diseases the drugs treat. Several studies suggest that con- sumer sensitivity to cost sharing de- pends on a drug’s therapeutic class4-7 and that increased cost sharing may de- crease “nonessential” drug use more than “essential” drug use.8,9 This makes identifying the therapeutic classes most sensitive to benefit changes critically important. We examined how changes in ben- efit design among privately insured populations affect use of the most com- monly used drug classes. In addition, we identified populations more likely to be at risk for adverse health effects and isolated their responsiveness to cos