Pharmaceutical Use and Cost among Insured Elderly. Abstract, Executive Summary and Final Report

摘要

The objectives of this study was to analyze the impact of changes in a Medicare supplemental insurance plan's prescription copayment on utilization and expenditures for pharmaceuticals, use of brand-name compared with generic drugs, and medical care utilization and expenditures. Data were from the Oregon Public Employees Retirement System for a 78-month period from July 1, 1988 through December 31, 1994. During this period the copayment amount increased several times. We analyzed the impact of the copayment changes on various measures of pharmaceutical and medical care utilization and costs, controlling for time trends and covarying factors. Most measures of pharmaceutical utilization and expenditures increased early in the study period, despite the increasing fixed-dollar copayment, but were significantly lower after the change to a 50% copayment. Generic dispensing increased dramatically with the 50% copayment. Changes in medical care utilization and costs were observed, but generally were not statistically significant. This study was not able to assess the impact of the observed changes on patient-level health. The 50% prescription copayment had a significant impact on expenditures for pharmaceuticals compared with the $5 to $15 copayments, without a significant impact on expenditures for medical care.