title: Benefit plan design and prescription drug utilization among asthmatics: do patient copayments matter?
abstract: The ratio of controller-to-reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan-level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. The 1995--2000 MarketScan claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities, and county-level income variables to patient-level asthma treatment patterns. We find that the controller-to-reliever ratio rose steadily over 1995--2000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. After controlling for other variables, however, plan-level mean out-of-pocket copayments were not found to have a statistically significant influence on patient-level asthma treatment patterns. On the other hand, physician/practice prescribing patterns strongly influenced patient-level treatment patterns. There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.
authors.forename: William H
authors.initials: WH
authors.lastname: Crown
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Berndt
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.forename: Stan N
authors.initials: SN
authors.lastname: Finkelstein
authors.forename: Whitney P
authors.initials: WP
authors.lastname: Witt
authors.forename: Jonathan
authors.initials: J
authors.lastname: Maguire
authors.forename: Kenan E
authors.initials: KE
authors.lastname: Haver
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics; D015897:Comorbidity; D003669:Deductibles and Coinsurance / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000191:economics*; D004363:Drug Utilization / Q000191:economics*; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D005382:Financing, Personal / Q000191:economics; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007342:Insurance Benefits / Q000191:economics; D007344:Insurance Claim Reporting / Q000191:economics; D007348:Insurance, Health / Q000191:economics*; D016015:Logistic Models; D008297:Male; D017059:Models, Econometric; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents