Craig BM; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 620.
UW-Madison, Population Health Sciences, 726 WARF, 610 Walnut Street, Madison, WI 53726-2397 Tel. (608) 265-3409 Fax (608) 263-2820
RESEARCH OBJECTIVE: This paper was motivated by fervent discussions among academics and policy makers over access to prescription medications and potential Medicare reforms. Interest in a universal outpatient drug benefit for seniors began with Medicare itself in the 1960s to address concerns for economic barriers to needed medications and financial burden of drug expenditures. Now, faced with double-digit growth in drug expenditures and increased availability of highly effective medications, congressional and senate leaders promise the expansion of Medicare to include such a benefit. However, the various plans put forth by the legislature have been assembled with parsimonious evidence on the out-of-pocket price for prescription medications faced by seniors. This paper: 1) examines the extent that drug coverage mitigates the financial burden of pharmacotherapy among seniors; 2) examines the relationship between out-of-pocket price and medication acquisition; and 3) examines the extent that out-of-pocket price influences the choice between alternative pharmacotherapies. STUDY DESIGN: Using the 1994 through 1999 Medicare Current Beneficiary Survey, a nationally representative overlapping panel survey, the out-of-pocket price of common single source prescription medications is modeled to explore the relationship between price and medication acquisition. Like wages, price is endogenously censored, which motivates the use of econometric techniques commonly applied in labor economics to control for potential confounding, specifically Heckman's two stage methods. POPULATION STUDIED: Elderly non-institutionalized Medicare beneficiaries that reside in the continental US, Alaska or Hawaii between 1994 and 1999 PRINCIPAL FINDINGS: Results from the study of antidepressants, one of the multiple therapeutic classes being examined, suggest that drug coverage lowers the prices of fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) by more than a dollar per unit (over 50%) and that these price reductions are associated with higher odds of medication acquisition (1.14, 1.43 and 1.50 times greater than otherwise, respectively). Furthermore, results suggest that higher prices for SSRIs are associated with an increased likelihood of acquiring first generation antidepressants (tricyclic antidepressants and monoamine oxidase inhibitor) and atypical antidepressants (e.g. Serzone or Effexor) among those who receive treatment for depression. CONCLUSIONS: These results suggest that economic barriers to access to pharmacotherapy remain even for those with drug coverage, that such differences in price are related to medication acquisition and the choice between alternative therapeutic regimens. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The uniqueness of this paper is three-fold: its focus on seniors in the United States and their financial burden of specific pharmacotherapies, its emphasis on out-of-pocket price as a key economic barrier to access, and its timeliness to inform the Medicare reform debate. The research provides policy makers estimates of the out-of-pocket price faced by seniors for multiple single-source prescription medications and the extent to which drug coverage mitigates this financial burden. Furthermore, it provides a tool that predicts changes in medication acquisition associated with lowered out-of-pocket prices. This research also has implications for quality of care and the role of price in the choice between pharmacotherapies. Such price-related differences in care among seniors may lead to noticeable inequality in health outcomes across health care systems, a hypothesis for future research.
Publication Types:
Keywords:
- Aged
- Alaska
- Hawaii
- Health Expenditures
- Humans
- Medicare
- Pharmaceutical Preparations
- Prescriptions, Drug
- Socioeconomic Factors
- United States
- economics
- hsrmtgs
Other ID:
UI: 102275591
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