目标:大多数65岁或以上的成年人有多种慢性疾病。用处方药管理这些疾病可能成本很高,特别是对于收入有限的老年人。
目的:在使用Medicare处方药计划(PDP)的老年人中,评估与指南推荐的门诊药物初始治疗8种常见慢性疾病相关的假设自付费用。
方法:这项回顾性横断面研究使用2009年和2019年Medicare处方药计划处方集文件来估算参加MedicareAdvantage或独立MedicarePartD计划的假设患者的年度自付费用。在应用纳入和排除标准后,共纳入2009年的3599个PDP和2019年的3618个PDP。与8种最常见慢性疾病的指南推荐药物相关的费用(心房颤动,慢性阻塞性肺疾病射血分数降低的心力衰竭,高胆固醇血症,高血压,骨关节炎,骨质疏松,和2型糖尿病),单独和在两个常见的合并症中,进行了检查。
方法:每种慢性病的年度自付费用,通胀调整至2019年美元。
结果:在2009年的3599个MedicarePDP中,1998年是MedicareAdvantage计划,1601是独立计划;在2019年的3618个MedicarePDP中,2719个是MedicareAdvantage计划,899个是独立计划。对于2019年参加任何MedicarePDP的老年人,个人疾病的年度自付费用中位数各不相同。最低32美元(IQR,$6-$48)用于指南建议的骨质疏松症管理(从$128[IQR,$102-$183]在2009年)至最高$1579(IQR,$1524-$2229)用于指南建议的房颤管理(从$91[IQR,2009年$73-$124])。对于患有5种常见合并症(COPD,高血压,骨关节炎,骨质疏松,和2型糖尿病)参加任何PDP,2019年自费成本中位数为1999美元(IQR,$1630-$2564),从2284美元下降12%(IQR,$1920-$3107),2009年。对于所有8种慢性疾病的老年人(心房颤动,COPD,糖尿病,高胆固醇血症,心力衰竭,高血压,骨关节炎,和骨质疏松症)参加任何PDP,2019年的自付成本中位数为3630美元(IQR,$3234-$5197),从2571美元增加41%(IQR,2009年$2185-$3719)。
结论:在这项横断面研究中,针对8种常见慢性疾病的初始治疗,指南推荐的门诊药物的自付费用因病情而异.尽管2009年至2019年期间成本普遍下降,特别是在提供仿制药的条件方面,自付费用仍然很高,可能给医疗保险受益人带来了巨大的财务负担,尤其是那些指南推荐使用品牌药的老年人.
OBJECTIVE: Most adults 65 years or older have multiple chronic conditions. Managing these conditions with prescription drugs can be costly, particularly for older adults with limited incomes.
OBJECTIVE: To estimate hypothetical out-of-pocket costs associated with
guideline-recommended outpatient medications for the initial treatment of 8 common chronic diseases among older adults with Medicare prescription drug plans (PDPs).
METHODS: This retrospective cross-sectional study used 2009 and 2019 Medicare prescription drug plan formulary files to estimate annual out-of-pocket costs among hypothetical patients enrolled in Medicare Advantage or stand-alone Medicare Part D plans. A total of 3599 PDPs in 2009 and 3618 PDPs in 2019 were included after inclusion and exclusion criteria were applied. Costs associated with
guideline-recommended medications for 8 of the most common chronic diseases (atrial fibrillation, chronic obstructive pulmonary disease [COPD], heart failure with reduced ejection fraction, hypercholesterolemia, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes), alone and in 2 clusters of commonly comorbid conditions, were examined.
METHODS: Annual out-of-pocket costs for each chronic condition, inflation adjusted to 2019 dollars.
RESULTS: Among 3599 Medicare PDPs in 2009, 1998 were Medicare Advantage plans and 1601 were stand-alone plans; among 3618 Medicare PDPs in 2019, 2719 were Medicare Advantage plans and 899 were stand-alone plans. For an older adult enrolled in any Medicare PDP in 2019, the median annual out-of-pocket costs for individual conditions varied, from a minimum of $32 (IQR, $6-$48) for
guideline-recommended management of osteoporosis (a decrease from $128 [IQR, $102-$183] in 2009) to a maximum of $1579 (IQR, $1524-$2229) for guideline-recommended management of atrial fibrillation (an increase from $91 [IQR, $73-$124] in 2009). For an older adult with a cluster of 5 commonly comorbid conditions (COPD, hypertension, osteoarthritis, osteoporosis, and type 2 diabetes) enrolled in any PDP, the median out-of-pocket cost in 2019 was $1999 (IQR, $1630-$2564), a 12% decrease from $2284 (IQR, $1920-$3107) in 2009. For an older adult with all 8 chronic conditions (atrial fibrillation, COPD, diabetes, hypercholesterolemia, heart failure, hypertension, osteoarthritis, and osteoporosis) enrolled in any PDP, the median out-of-pocket cost in 2019 was $3630 (IQR, $3234-$5197), a 41% increase from $2571 (IQR, $2185-$3719) in 2009.
CONCLUSIONS: In this cross-sectional study, out-of-pocket costs for
guideline-recommended outpatient medications for the initial treatment of 8 common chronic diseases varied by condition. Although costs generally decreased between 2009 and 2019, particularly with regard to conditions for which generic drugs were available, out-of-pocket costs remained high and may have presented a substantial financial burden for Medicare beneficiaries, especially older adults with conditions for which brand-name drugs were
guideline recommended.