PDF(Pubmed)
Abstract：
UNASSIGNED: The lowest-income beneficiaries enrolled in the Medicare Part D prescription drug program receive \"full subsidies\" that waive the premium and deductible and impose minimal copayments. Those with slightly higher incomes and assets may be eligible for \"partial subsidies.\" Prior to 2024, individuals receiving partial subsidies faced reduced Part D premiums and deductibles and paid 15% coinsurance. Under provisions of the Inflation Reduction Act, recipients of partial subsidies were upgraded to full subsidies beginning in 2024. The objective of this pilot study was to assess whether the new policy is likely to reduce cost-related nonadherence to prescribed medications- a common problem faced by older adults even among those receiving subsidies.
UNASSIGNED: To compare cost-related nonadherence among partial- vs full-subsidy recipients with similar characteristics.
UNASSIGNED: We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on low-income subsidy enrollment plus extensive survey-based information on financial resources necessary to establish program eligibility and rates of cost-related nonadherence. Explanatory variables included sociodemographic characteristics, economic resources, work status, and health variables.
UNASSIGNED: We found that the partial-subsidy group reported significantly more cost-related nonadherence (39% vs 22%; P = 0.01) arising both from a lower propensity to fill some prescriptions (23% vs 12%; P = 0.03) and to more delays in filling others (29% vs 8%; P = 0.03). The differences were more pronounced for women and racial and ethnic minority groups in contrast to men and majority populations, respectively. Because the study samples were small, we could not conduct a detailed regression analysis.
UNASSIGNED: The magnitude of cost-related nonadherence effects associated with partial-subsidy cost sharing suggests that the Inflation Reduction Act policy to expand low-income subsidies may boost medication adherence, most notably among women and racial and ethnic minority groups.
UNASSIGNED: To compare cost-related nonadherence among partial- vs full-subsidy recipients with similar characteristics.
UNASSIGNED: We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on low-income subsidy enrollment plus extensive survey-based information on financial resources necessary to establish program eligibility and rates of cost-related nonadherence. Explanatory variables included sociodemographic characteristics, economic resources, work status, and health variables.
UNASSIGNED: We found that the partial-subsidy group reported significantly more cost-related nonadherence (39% vs 22%; P = 0.01) arising both from a lower propensity to fill some prescriptions (23% vs 12%; P = 0.03) and to more delays in filling others (29% vs 8%; P = 0.03). The differences were more pronounced for women and racial and ethnic minority groups in contrast to men and majority populations, respectively. Because the study samples were small, we could not conduct a detailed regression analysis.
UNASSIGNED: The magnitude of cost-related nonadherence effects associated with partial-subsidy cost sharing suggests that the Inflation Reduction Act policy to expand low-income subsidies may boost medication adherence, most notably among women and racial and ethnic minority groups.
摘要：
■参加MedicareD部分处方药计划的最低收入受益人将获得“全额补贴”，免除保费和自付额，并施加最低共付额。那些收入和资产略高的人可能有资格获得“部分补贴”。“在2024年之前，接受部分补贴的个人面临减少的D部分保费和免赔额，并支付15%的共同保险金。根据《降低通货膨胀法》的规定，从2024年开始，部分补贴的接受者升级为全额补贴。这项试点研究的目的是评估新政策是否有可能减少与成本相关的处方药依从性-这是老年人甚至在接受补贴的人群中面临的常见问题。
■比较具有相似特征的部分补贴接受者与全额补贴接受者之间与成本相关的不依从性。
■我们使用2019年医疗保险当前受益人调查数据进行研究。Medicare当前受益人调查非常适合这项工作，因为它包含有关低收入补贴入学的行政数据，以及有关建立计划资格和与成本相关的不依从率所需的财务资源的广泛调查信息。解释变量包括社会人口统计学特征，经济资源,工作状态,和健康变量。
■我们发现，部分补贴组报告的与成本相关的不依从性明显增加（39％对22％；P=0.01），原因是某些处方的填充倾向降低（23％对12％；P=0.03）和其他处方的延迟增加（29％对8％；P=0.03）。与男性和多数人口相比，女性和种族和少数族裔群体的差异更为明显，分别。因为研究样本很小，我们无法进行详细的回归分析。
■与部分补贴成本分担相关的成本相关的非依从性效应的程度表明，扩大低收入补贴的《降低通货膨胀法》政策可能会提高药物依从性，尤其是在妇女和种族和少数族裔群体中。
■比较具有相似特征的部分补贴接受者与全额补贴接受者之间与成本相关的不依从性。
■我们使用2019年医疗保险当前受益人调查数据进行研究。Medicare当前受益人调查非常适合这项工作，因为它包含有关低收入补贴入学的行政数据，以及有关建立计划资格和与成本相关的不依从率所需的财务资源的广泛调查信息。解释变量包括社会人口统计学特征，经济资源,工作状态,和健康变量。
■我们发现，部分补贴组报告的与成本相关的不依从性明显增加（39％对22％；P=0.01），原因是某些处方的填充倾向降低（23％对12％；P=0.03）和其他处方的延迟增加（29％对8％；P=0.03）。与男性和多数人口相比，女性和种族和少数族裔群体的差异更为明显，分别。因为研究样本很小，我们无法进行详细的回归分析。
■与部分补贴成本分担相关的成本相关的非依从性效应的程度表明，扩大低收入补贴的《降低通货膨胀法》政策可能会提高药物依从性，尤其是在妇女和种族和少数族裔群体中。
