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Abstract：
Medicare supplement insurance, or Medigap, covers 21% of Medicare beneficiaries. Despite offsetting some out-of-pocket (OOP) expenses, remaining OOP costs may pose a barrier to medication adherence. This study aims to evaluate how OOP costs and insurance plan types influence medication adherence among beneficiaries covered by Medicare supplement plans.
We conducted a retrospective analysis of the Merative MarketScan Medicare Supplement Database (2017-2019) in Medigap enrollees (≥65 years) with hypertension. The proportion of days covered (PDC) was a continuous measure of medication adherence and was also dichotomized (PDC ≥0.8) to quantify adequate adherence. Beta-binomial and logistic regression models were used to estimate associations between these outcomes and insurance plan type and log-transformed OOP costs, adjusting for patient characteristics.
Among 27,407 patients with hypertension, the average PDC was 0.68 ± 0.31; 47.5% achieved adequate adherence. A mean $1 higher in 30-day OOP costs were associated with a 0.06 (95% confidence intervals [CIs]: -0.09 to -0.03) lower probability of adequate adherence, or a 5% (95% CI: 4%-7%) decrease in PDC. Compared with comprehensive plan enrollees, the odds of adequate adherence were lower among those with point-of-service plans (odds ratio [OR]: 0.69, 95% CI: 0.62-0.77), but higher among those with preferred provider organization (PPO) plans (OR: 1.08, 95% CI: 1.01-1.15). Moreover, the association between OOP costs and PDC was significantly greater for PPO enrollees.
While Medicare supplement insurance alleviates some OOP costs, different insurance plans and remaining OOP costs influence medication adherence. Reducing patient cost-sharing may improve medication adherence.
We conducted a retrospective analysis of the Merative MarketScan Medicare Supplement Database (2017-2019) in Medigap enrollees (≥65 years) with hypertension. The proportion of days covered (PDC) was a continuous measure of medication adherence and was also dichotomized (PDC ≥0.8) to quantify adequate adherence. Beta-binomial and logistic regression models were used to estimate associations between these outcomes and insurance plan type and log-transformed OOP costs, adjusting for patient characteristics.
Among 27,407 patients with hypertension, the average PDC was 0.68 ± 0.31; 47.5% achieved adequate adherence. A mean $1 higher in 30-day OOP costs were associated with a 0.06 (95% confidence intervals [CIs]: -0.09 to -0.03) lower probability of adequate adherence, or a 5% (95% CI: 4%-7%) decrease in PDC. Compared with comprehensive plan enrollees, the odds of adequate adherence were lower among those with point-of-service plans (odds ratio [OR]: 0.69, 95% CI: 0.62-0.77), but higher among those with preferred provider organization (PPO) plans (OR: 1.08, 95% CI: 1.01-1.15). Moreover, the association between OOP costs and PDC was significantly greater for PPO enrollees.
While Medicare supplement insurance alleviates some OOP costs, different insurance plans and remaining OOP costs influence medication adherence. Reducing patient cost-sharing may improve medication adherence.
摘要：
背景：医疗保险补充保险，或Medigap，覆盖21%的医疗保险受益人。尽管抵消了一些自付(OOP)费用，剩余的OOP费用可能对药物依从性构成障碍。本研究旨在评估OOP成本和保险计划类型如何影响Medicare补充计划涵盖的受益人的药物依从性。
方法：我们对患有高血压的Medigap参与者（≥65岁）的MerativeTMMarketScan®Medicare补充数据库（2017-2019）进行了回顾性分析。覆盖天数比例（PDC）是药物依从性的连续量度，也被二分法（PDC≥0.8）以量化足够的依从性。使用β-二项和逻辑回归模型来估计这些结果与保险计划类型和对数转换的OOP成本之间的关联。根据患者特征进行调整。
结果：在27,407例高血压患者中，平均PDC为0.68±0.31;47.5%达到了足够的依从性.30天OOP费用平均高1美元与0.06(95%置信区间[CI]:-0.09--0.03)较低的充分依从性概率相关，或PDC下降5%(95%C.I.:4%-7%)。与综合计划登记者相比，在有服务点计划的人中，充分坚持的可能性较低(O.R.：0.69，95%C.I.：0.62-0.77)，但在那些有首选提供者组织(PPO)计划的人中更高(O.R.:1.08,95%C.I.:1.01-1.15)。此外，PPO参与者的OOP成本和PDC之间的关联显著更大.
结论：虽然医疗保险补充保险减轻了一些OOP费用，不同的保险计划和剩余的OOP成本会影响药物依从性。减少患者费用分担可以提高药物依从性。
方法：我们对患有高血压的Medigap参与者（≥65岁）的MerativeTMMarketScan®Medicare补充数据库（2017-2019）进行了回顾性分析。覆盖天数比例（PDC）是药物依从性的连续量度，也被二分法（PDC≥0.8）以量化足够的依从性。使用β-二项和逻辑回归模型来估计这些结果与保险计划类型和对数转换的OOP成本之间的关联。根据患者特征进行调整。
结果：在27,407例高血压患者中，平均PDC为0.68±0.31;47.5%达到了足够的依从性.30天OOP费用平均高1美元与0.06(95%置信区间[CI]:-0.09--0.03)较低的充分依从性概率相关，或PDC下降5%(95%C.I.:4%-7%)。与综合计划登记者相比，在有服务点计划的人中，充分坚持的可能性较低(O.R.：0.69，95%C.I.：0.62-0.77)，但在那些有首选提供者组织(PPO)计划的人中更高(O.R.:1.08,95%C.I.:1.01-1.15)。此外，PPO参与者的OOP成本和PDC之间的关联显著更大.
结论：虽然医疗保险补充保险减轻了一些OOP费用，不同的保险计划和剩余的OOP成本会影响药物依从性。减少患者费用分担可以提高药物依从性。
