| Many health maintenance organizations (HMOs) have implemented programs providing varying degrees of annual drug coverage for Medicare beneficiaries enrolled in their plans. Senior plan members in an HMO were able to choose among 3 drug benefit options: full coverage for prescription drugs, a maximum of {dollar}1000/year in coverage, or no drug coverage. Cost containment policies have been shown to affect prescription drug use and other types of health service utilization. This research investigated the effects of plan type chosen on use of lipid lowering agents (LLA), a group of drugs of well-documented benefit in coronary heart disease (CHD) prevention.; The objectives were (a) to describe LLA utilization during a one-year period, for both prevalent and new users, and to compare this utilization with patient characteristics including plan type; (b) to examine differences in persistence to LLAs among members of different plans; (c) to determine the effect of plan choice on the type of statin drugs, a class of LLAs, prescribed based on relative price.; Analyses were performed using 2229 members. Of these, 1551 were studied in paper 1,322 in paper 2, and 484 in paper 3.; Statins were the most widely prescribed among both prevalent (61.8%) and new (65.5%) users, and a low rate of combination therapy was found in both prevalent (1.6%) and new (0.9%) users.; The plan type did not affect choice among LLAs, but comorbidities, mainly CHD and diabetes, seem to be among the main factors that influenced selection.; The overall discontinuation rate for LLAs increased with time from 18.3% after 6 months, to 46.4% at 12 months, to 66.3% at 18 months.; Statin users had better persistence than non-statin users (HR = 0.536; CI = 0.375--0.766; p = 0.0006). No significant differences in persistence existed with plan type (HR = 0.877; CI = 0.610--1.260; p = 0.4777).; There was no significant association between the plan type and statin type prescribed (OR = 0.654; CI = 0.376--1.139; p = 0.1335).; In sum, research results generally indicate that the policy initiated did not significantly influence the choice among or persistence to LLAs. |
