Comparing patient OOP spending for specialty drugs in Medicare Part D and employer-sponsored insurance.
Am J Manag Care
; 26(9): 388-394, 2020 09.
Article
en En
| MEDLINE
| ID: mdl-32930551
ABSTRACT
OBJECTIVES:
Per capita spending on specialty drugs increased 55% between 2014 and 2018. Individuals aged 55 to 75 years using specialty drugs make the transition from employer-sponsored insurance (ESI) to Medicare Part D coverage. We compared out-of-pocket (OOP) spending across ESI, Medicare fee-for-service (FFS), and Medicare Advantage (MA) prescription drug plans to examine the impact of benefit design on OOP spending. STUDYDESIGN:
Analyses consisted of Truven MarketScan and Medicare Part D prescription drug claims from 2013 to 2017 for individuals enrolled in ESI, FFS, and MA drug plans taking at least 1 drug among the top 4 specialty drug classes rheumatoid arthritis (RA), multiple sclerosis (MS), cancer, and hepatitis C.METHODS:
Multivariate regression analyses with fixed effects were used to assess whether there are differences in OOP spending by insurance type and the impact of benefit design differences. A secondary outcome was drug choice within a therapeutic class.RESULTS:
There were small differences in drug choice between Medicare and ESI but significant differences in OOP spending. Monthly OOP spending for ESI relative to FFS was $108 less for RA drugs, $288 less for MS drugs, $504 less for cancer drugs, and $1437 less for hepatitis C drugs. Spending was slightly greater for beneficiaries in MA plans compared with FFS. Higher Medicare spending was driven by gaps in coverage in the Part D benefit phases because beneficiaries pay a percentage of list price.CONCLUSIONS:
OOP spending was substantially higher for Medicare enrollees compared with ESI enrollees as a result of the Part D benefit structure.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_financiamento_saude
Asunto principal:
Artritis Reumatoide
/
Gastos en Salud
/
Medicare Part D
/
Medicamentos bajo Prescripción
/
Esclerosis Múltiple
Límite:
Aged
/
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2020
Tipo del documento:
Article