The 130th Annual Meeting of APHA

Abstract #46103

Whitney P. Witt, PhD, MPH¹, William H. Crown, PhD², Jonathan Maguire, BA², Ernst R. Berndt, PhD³, and Stan N. Finkelstein, MD³. (1) Massachusetts General Hospital for Children, Center for Child and Adolescent Health Policy, Harvard University, School of Medicine, 50 Staniford Street, Suite 901, Boston, MA 02114, (617) 724-2845, wwitt@partners.org, (2) Outcomes Research & Econometrics, The MEDSTAT Group, Inc., 125 CambridgePark Drive, Cambridge, MA 02140, (3) Sloan School of Management, MIT, MIT, E52-452, 50 Memorial Drive, Cambridge, MA 02142-1347

In an attempt to constrain rising expenditures on prescription drugs, insurers/employers have recently implemented three-tier co-payment schemes. Pharmaceutical interventions are critical in the treatment and management of asthma; however the impact of the pharmaceutical benefit design on access to and use of asthma medications is unknown. This paper quantifies and evaluates the effects of the three-tier co-payment schemes on asthma prescription drug and medical care utilization. The data sources for this study are administrative medical claims and enrollment data from a large employer database managed by the MEDSTAT Group, and cover over 90,000 asthmatic episodes for employees and their dependents, nationwide. Data encompass the 1995-99 time period, for asthmatics receiving care in either a fee-for-service (FFS) or HMO managed care context. Race, ethnicity, and income information will be extracted from the Bureau of Health Professions Area Resource File (ARF), a compendium of county-level information produced annually, and merged with the MEDSTAT analytic file by county. The sample consists of 90,998 asthmatics, with a mean age of 33 years. Over half (56%) of the subjects were female and living in either the Northeast or North Central regions of the US (66%). The mean insuree co-payments for a prescription medication were $5.63 for FFS coverage and $8.65 for HMO coverage. Nearly 25% of the sample also had an asthma-specific comorbidity. Preliminary unadjusted results suggest that three-tier benefit plan design is significantly associated with use of medical services, however this relationship varies by insurance plan type and the specific setting of the service. Multivariate regression analysis will determine the role of benefit plan design in prescription drug selection, service use patterns, guideline adherence and medical outcomes. The empirical analysis is greatly enhanced by observed variation in benefit plan design, both over time and cross-sectionally. The results of this study will be important for insurance plans, employers, policy makers, and consumers in understanding whether asthmatic patients’ access to and choice of medications is affected by benefit plan design.

Learning Objectives: At the conclusion of the session the participant in this session will be able to

• Describe how and why pharmacy benefit designs have changed considerably over the past decade. 2.) Characterize pharmaceutical interventions in the treatment and management of asthma; and discuss the importance of access to medication and healthcare services for asthmatics.
• Articulate the impact of pharmaceutical benefit design on clinical and economic outcomes of asthmatic employees or their dependents with asthma.

Keywords: Asthma, Prescription Drug Use Patterns

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: part-time employee of The MEDSTAT Group, Inc. which owns the Marketscan database (used in study)