changes in drug utilization during a gap in insurance coverage an examination of the medicare part d coverage gap药物利用率变化差距中保险医疗保险d部分覆盖缺口的考试.pdfVIP

Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap 1,2 1,2 2 1,2,3,4 Jennifer M. Polinski *, William H. Shrank , Haiden A. Huskamp , Robert J. Glynn , Joshua N. Liberman5, Sebastian Schneeweiss1,2 1 Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America, 2 Harvard Medical School, Boston, Massachusetts, United States of America, 3 Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America, 4 Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America, 5 CVS Caremark, Hunt Valley, Maryland, United States of America Abstract 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 pres