文章基本信息

标题：Prescription Drug Insurance Coverage and Patient Health Outcomes: A Systematic Review
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作者：Aaron S. Kesselheim ; Krista F. Huybrechts ; Niteesh K. Choudhry 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：2
页码：e17-e30
DOI：10.2105/AJPH.2014.302240
语种：English
出版社：American Public Health Association
摘要：Previous reviews have shown that changes in prescription drug insurance benefits can affect medication use and adherence. We conducted a systematic review of the literature to identify studies addressing the association between prescription drug coverage and health outcomes. Studies were included if they collected empirical data on expansions or restrictions of prescription drug coverage and if they reported clinical outcomes. We found 23 studies demonstrating that broader prescription drug insurance reduces use of other health care services and has a positive impact on patient outcomes. Coverage gaps or caps on drug insurance generally led to worse outcomes. States should consider implementing the Affordable Care Act expansions in drug coverage to improve the health of low-income patients receiving state-based health insurance. Health care costs are one of the most important modern-day health policy issues. The United States spends more per capita on health care than any other country, with the percentage of gross domestic product dedicated to health care doubling from 9% in 1980 to 18% in 2011. 1 Costs related to implementation of the federal Medicare health insurance program are considered one of the key contributors to slowed US economic expansion. 2 Prescription drugs have been substantial contributors to health care inflation. Pharmaceuticals account for about 10% of total health care costs, and although spending on pharmaceuticals has recently slowed, it is poised to swell in upcoming years as a result of the increasing prices of complex specialty medicines. 3 One response to this trend from public and private insurers has been to place firm restrictions on the availability of prescription drugs or to exclude certain drugs from coverage altogether. In 2009, Medicaid, the federal- and state-funded health care insurance program for the poor, spent about $25 billion on pharmaceuticals, making it one of the largest single purchasers of prescription drugs in the United States. 4 From 2010 to 2012, 7 states imposed new limits or tightened existing limits on the number of prescription drugs routinely covered by their Medicaid programs. Currently, 16 different states have such limits; in Illinois, for example, Medicaid recipients’ insurance plans now cover a maximum of only 4 prescription drugs per month without prior authorization. 5 Collateral effects will emerge from insurance changes that restrict the availability of prescription drugs or exclude patients from accessing them. One predictable effect will be on spending. Numerous previous studies have shown that expenses related to broader insurance coverage of essential prescription drugs result in lower or the same level of overall health care spending. 6–11 For example, in their randomized study of prescription drug coverage expansion, Choudhry et al. found that increased spending by one large insurer on prescription drugs in the form of reduced enrollee copays on certain categories of drugs did not lead to overall increases in health costs. 12 Another expected collateral effect will be on medication adherence. A recent systematic review of value-based insurance design programs, in which patient copayments were reduced for medications used to treat chronic diseases, showed that reduced out-of-pocket patient spending was consistently associated with improved medication adherence. 13 Although the effects of drug insurance design changes on health care spending and medication adherence have been demonstrated, the effects on patient morbidity and mortality are less well understood. With the recent limits in drug coverage enacted by certain state Medicaid programs and the possibility of substantial expansion of drug insurance benefits offered by the implementation of the Affordable Care Act (Pub L No. 111-148), we conducted a systematic review to determine how expansions or restrictions in prescription drug insurance have affected patients’ health outcomes or their use of health care services.