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.
Christian-Herman
Jennifer
J
Health Services Research, Cerner Health Insights, Beverly Hills, California, USA. jennifer.christian-herman@cerner.com
Emons
Matthew
M
George
Dorothy
D
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