Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices.. Mix of Drugs

04/01/2000

Another consequence of not having drug coverage may be the use of a different mix of drugs. In addition to not filling some prescriptions, some people without drug coverage may obtain different prescriptions compared to the prescriptions that people with drug coverage get. Preliminary analysis of MCBS data on Medicare beneficiary utilization of medications commonly associated with the treatment of hypertension (categorized as diuretics, calcium channel blockers, beta blockers and anti-hypertensives)29 suggests that:

  • Beneficiaries with prescription drug coverage were more likely to be dispensed a generic drug for all of the drug categories; beneficiaries without coverage were more likely to be dispensed a brand name product. Presumably, beneficiaries with coverage are more likely to be encouraged (or required) to use generic products by the health plan or pharmacy benefit manager.30
  • The average number of units dispensed per prescription was higher for people with prescription drug coverage. Individuals with prescription drug coverage may be purchasing a supply of drugs to last a longer period of time (for example, a 30 day supply rather than a 14 day supply). Individuals without coverage also may be skipping doses to avoid higher out-of-pocket costs (for example, taking medication once per day instead of twice per day).

One issue the analysis raises for future work is the possibility of a connection between insurance status and “step therapy.” That is, beneficiaries with insurance could be more likely to have a drug or combination of drugs prescribed and dispensed that is more responsive to a particular patient (and perhaps more expensive). For example, a physician may prescribe an increased drug dose, substitute another drug, or add a second agent from a different class of drugs if a patient is not responding adequately to current drug therapy. More work is necessary to discern whether or not beneficiaries with drug coverage are more likely to be prescribed or fill those additional prescriptions, and take them at appropriate dosages.

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