Pharmacy benefit caps and the chronically ill.
In this paper we examine medication use among retirees with employer-sponsored drug coverage both with and without annual benefit limits. We find that pharmacy benefit caps are associated with higher rates of medication discontinuation across the most common therapeutic classes and that only a minority of those who discontinue use reinitiate therapy once coverage resumes. Plan members who reach their cap are more likely than others to switch plans and increase their rate of generic use; however, in most cases, the shift is temporary. Given the similarities between these plans and Part D, we make some inferences about reforms for Medicare.
Joyce
Geoffrey F
GF
RAND, Santa Monica, California, USA. gjoyce@rand.org
Goldman
Dana P
DP
Karaca-Mandic
Pinar
P
Zheng
Yuhui
Y
D000368:Aged; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy; D003363:Cost Control; D011307:Drug Prescriptions / Q000191:economics; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D006264:Health Benefit Plans, Employee / Q000191:economics*; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics; D054524:Medicare Part D / Q000706:statistics & numerical data*; D054539:Medication Therapy Management; D010349:Patient Compliance; D012179:Retirement / Q000191:economics*; D012720:Severity of Illness Index; D014481:United States
D016568:Drugs, Generic