The impact of Medicare prescription drug coverage on the use of antidementia drugs

BMC Geriatrics

Julie M Donohue⁴  Eric G Rodriguez¹  Aiju Men⁴  Christiana A Thurton²  Yi-Fan Chen³  Nicole R Fowler¹ 

[1] Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Department of Community Health, CUNY School of Public Health at Hunter College, New York, NY, USA;Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA;Department of Health Policy and Management, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA

关键词: Drug coverage;    Memantine;    Cholinesterase inhibitors;    Medicare Part D;    Alzheimer’s disease;    Dementia;   

Others  :  857747
DOI  :  10.1186/1471-2318-13-37

 received in 2012-07-25, accepted in 2013-04-17,  发布年份 2013

【 摘 要 】

Background

Cholinesterase inhibitors and memantine are prescribed to slow the progression dementia. Although the efficacy of these drugs has been demonstrated, their effectiveness, from the perspective of patients and caregivers, has been questioned. Little is known about whether the demand for cholinesterase inhibitors and memantine are sensitive to out-of-pocket cost. Using the 2006 implementation of Medicare Part D as a natural experiment, this study examines the impact of changes in drug coverage on use of cholinesterase inhibitors and memantine by comparing use before and after Medicare Part D implementation among older adults who did and did not experience a change in coverage.

Methods

Retrospective analyses of claims data from 35,102 community-dwelling Medicare beneficiaries in Pennsylvania aged 65 or older. Beneficiaries were continuously enrolled in a Medicare Advantage plan from 2004 to 2007. Outcome variables were any use of donepezil (Aricept®), galantamine (Razadyne®), rivastigmine (Exelon®), tacrine (Cognex®), or memantine (Namenda®) each year and the number of 30-day prescriptions filled for these drugs. Independent variables included type of drug benefit pre–Part D (No coverage, $150 cap, $350 cap, and No cap as the reference group), time period, and their interaction. Sensitivity analyses were conducted to test if there are differences in use by drug class or if beneficiaries with a diagnosis of dementia pre–Part D experienced an increase in use post–Part D.

Results

The No coverage group had a 38% increase in the odds ratio of any use of antidementia medications (P = 0.0008) post–Part D relative to the No cap group. All four coverage groups had significant increases in number of 30-day prescriptions (P < 0.001) over the study period. In adjusted models that included the sub-sample with any use pre–Part D, the No coverage group had a 36% increase in prescriptions (P = 0.002) and the $350 cap group had a 15% increase (P = 0.003) after adjusting for trends in the No cap group. Results from the sensitivity analysis for the sub-sample with a diagnosis of dementia pre–Part D show that each group had significant increases in 30-day prescriptions compared to the No cap control group (P < 0.05).

Conclusions

Use of cholinesterase inhibitors and memantine in our sample increased and a greater increase in use was observed among Medicare beneficiaries who experienced improvements in drug coverage under Medicare Part D.

【 授权许可】

   
2013 Fowler et al.; licensee BioMed Central Ltd.

【 图 表 】

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