Effects of generic-only drug coverage in a Medicare HMO.
Rising pharmacy costs and demand for prescription drug coverage for broader populations of seniors have resulted in the implementation of generic-only pharmacy benefits in Medicare health maintenance organizations (HMOs). The impact on cost and quality of care is unknown. We examined data for members of a California Medicare HMO whose coverage changed to a generic-only benefit and found that the change was associated with reduced health plan pharmacy cost, increased out-of-pocket pharmacy costs for members, increased overall hospital admissions, changed drug-use patterns, and a negative impact on quality metrics for certain conditions. These findings have important implications for future research and health policy decisions.
Health Services Research, Cerner Health Insights, Beverly Hills, California, USA. jennifer.christian-herman@cerner.com
Jennifer
J
Christian-Herman
Matthew
M
Emons
Dorothy
D
George
D000368:Aged; D000369:Aged, 80 and over; D003363:Cost Control; D016568:Drugs, Generic / Q000191:economics*; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D007356:Insurance, Pharmaceutical Services; D006278:Medicare / Q000458:organization & administration*; D011787:Quality of Health Care
D016568:Drugs, Generic