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- Title
Cost-Lowering Strategies Used by Medicare Beneficiaries Who Exceed Drug Benefit Caps and Have a Gap in Drug Coverage.
- Authors
Tseng, Chien-Wen; Brook, Robert H.; Keeler, Emmett; Steers, W. Neil; Mangione, Carol M.
- Abstract
Context The majority of Medicare drug benefits in managed care (Medicare + Choice) have annual dollar limits or caps and many beneficiaries face temporary but potentially significant gaps in coverage after exceeding caps before the end of the year. In the new national Medicare drug benefit, beneficiaries with high medication expenditures will also face a period without drug coverage when their total drug costs exceed annual caps but are not high enough to qualify for catastrophic coverage. Objective To describe strategies adopted by beneficiaries exceeding annual drug benefit caps to lower prescription costs, the type of medications involved, and their financial burden. Design, Setting, and Participants A survey (completed in 2002) of Medicare + Choice beneficiaries aged 65 years and older with high medication costs and benefits capped on the plan's share of drug costs (65% response rate). The different caps offered in different counties were used as a natural experiment. Study participants (n = 665) exceeded a $750 or $1200 yearly cap in 2001 and had coverage gaps of 75 to 180 days. Control participants (n = 643) had $2000 caps, which they did not exceed. Study and control participants were matched by average total drug expenditures per month. Main Outcome Measures Proportion of beneficiaries reporting specific strategies to decrease medication costs, medications affected, and difficulty paying for prescriptions. Results In multivariate analyses adjusting for demographic and health characteristics, a higher proportion of patients exceeding caps reported using less prescribed medication than controls (18% vs 10%, respectively; P<.001), but similar proportions reported stopping medications completely (8% for both, P = .86) and of not starting prescribed medications (6% vs 5%, P = .39). Patients exceeding caps more often called pharmacies to find the best price (46% vs 29%, P<.001), switched medications (15% vs 9%, P = .002), used samples (34% vs 27%, P = ....
- Subjects
UNITED States; MEDICARE; MEDICAL care costs; MEDICARE beneficiaries; HEALTH insurance; MEDICAL care for older people; MEDICAL economics
- Publication
JAMA: Journal of the American Medical Association, 2004, Vol 292, Issue 8, p952
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.292.8.952