Growth in prescription drug spending among insured elders

Health Affairs

Volumn 20, Issue 5, 2001, Pages 265-277

  Thomas, Cindy Parks ^a   Ritter, Grant ^b   Wallach, Stanley S ^a  

^a BRANDEIS UNIVERSITY   (United States)

^b Brandeis University ^*

Author keywords

[No Author keywords available]

Indexed keywords

AGE; AGED; ARTICLE; DRUG COST; DRUG UTILIZATION; ECONOMICS; FEMALE; HEALTH CARE COST; HEALTH INSURANCE; HUMAN; INSURANCE; MALE; MEDICARE; MIDDLE AGED; UNITED STATES;

AGE FACTORS; AGED; AGED, 80 AND OVER; DRUG COSTS; DRUG UTILIZATION; FEMALE; HEALTH EXPENDITURES; HUMANS; INSURANCE BENEFITS; INSURANCE CLAIM REPORTING; INSURANCE, PHARMACEUTICAL SERVICES; MALE; MEDICARE; MIDDLE AGED; UNITED STATES;

EID: 0035460308     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.20.5.265     Document Type: Article

References (22)

1. Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Report to the President: Prescription Drug Spending, Utilisation, Coverage, and Prices (Washington: ASPE, May 2000).
2. S.M. Willcox, D.U. Himmelstein, and S. Woolhandler, "Inappropriate Drug Prescribing for the Community-Dwelling Elderly," Journal of the American Medical Association 272, no. 4 (1994): 292-296; and U.S. General Accounting Office, Prescription Drugs and the Elderly: Many Still Receive Potentially Harmful Drugs Despite Recent Improvements, Pub. no. GAO/HEHS-95-152 (Washington: GAO, 1996).
3. S.M. Willcox, D.U. Himmelstein, and S. Woolhandler, "Inappropriate Drug Prescribing for the Community-Dwelling Elderly," Journal of the American Medical Association 272, no. 4 (1994): 292-296; and U.S. General Accounting Office, Prescription Drugs and the Elderly: Many Still Receive Potentially Harmful Drugs Despite Recent Improvements, Pub. no. GAO/HEHS-95-152 (Washington: GAO, 1996).
4. The data were provided by PCS Health Systems, prior to its purchase by Advance Paradigm Health Systems, forming AdvancePCS. At the time the claims were incurred, PCS Health Systems covered fifty million lives.
5. The proportion of elderly in our database ages 65-74 ranged between 62 percent and 64 percent compared with the U.S. elderly in 2000 (and the 1997 MCBS) of 52 percent. There also are fewer elderly age eighty-five and older: 67 percent of our elderly sample, compared with 12 percent nationally.
6. We excluded any claims that were for prescription-related supplies (for example, special shampoos, batteries); medications in strengths available over the counter (for example, Motrin, 200 mg, or ibuprofen, 200 mg); or any injectable medications routinely administered only in the hospital.
7. Bureau of Labor Statistics, "Consumer Price Indexes," Inflation Calculator, 〈www.bls.gov/cpihome.htm〉 (28 May 2001).
8. There are twenty-two therapeutic categories as measured by this index.
9. It is likely that the very high cost users also include a large number of persons who are using high-cost medications to treat one or two expensive conditions such as cancer or neurological disease.
10. One limitation in interpreting the data is the large "miscellaneous" category. This category likely includes anticancer medications and several expensive new medications. The number of people who incur very high costs from a limited number of very expensive medications is likely to be small but clearly warrants further analysis.
11. This portion of the analysis excludes persons who disappeared from enrollment files by 2000. Such persons have either died, switched from AdvancePCS to another PBM, or lost prescription drug coverage.
12. N.E. Coulson and B. Stuart, "Persistence in the Use of Pharmaceuticals by the Elderly,"Journal of Health Economics 11, no. 3 (1992): 315-328.
13. E.P. Steinberg et al., "Beyond Survey Data: A Claims-Based Analysis of Drug Use and Spending by the Elderly," Health Affairs (Mar/Apr 2000): 198-211.
14. ASPE, Report to the President, Table 2-14.
15. Ibid., Tables 2-15-2-17.
16. Ibid., Table 2-1.
17. Ibid., Table 2-3.
18. Ibid., Table 2-23; and J.A. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries With and Without Drug Coverage," Health Affairs (Mar/Apr 2001): 74-85.
19. Ibid., Table 2-23; and J.A. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries With and Without Drug Coverage," Health Affairs (Mar/Apr 2001): 74-85.
20. Poisal and Murray, "Growing Differences."
21. T.S. Rector, "Exhaustion of Drug Benefits and Disenrollment of Medicare Beneficiaries from Managed Care Organizations," Journal of the American Medical Association 283, no. 16 (2000): 2163-2167; and E.R. Cox, B.R. Motherall, and K. Fairman, "Exhaustion of Prescription Drug Benefits and Medicare Beneficiaries Disenrollment from Managed Care," Journal of the American Medical Association 284, no. 2 (2000): 2596-2597.
22. T.S. Rector, "Exhaustion of Drug Benefits and Disenrollment of Medicare Beneficiaries from Managed Care Organizations," Journal of the American Medical Association 283, no. 16 (2000): 2163-2167; and E.R. Cox, B.R. Motherall, and K. Fairman, "Exhaustion of Prescription Drug Benefits and Medicare Beneficiaries Disenrollment from Managed Care," Journal of the American Medical Association 284, no. 2 (2000): 2596-2597.