Managed care patients get more meds

June 1, 2003

Pharmaceutical Representative

Chronic disease patients in managed care plans were consistently more likely to receive medications recommended for their conditions than were patients covered by traditional indemnity in 1997.

Getting needed medicines

The most likely explanation is that managed care enrollees have lower out-of-pocket medication costs thanks to prescription drug benefits, which most managed care plans have but indemnity plans lack, explained Randall Stafford, assistant professor of medicine at the Stanford Center for Research in Disease Prevention and lead author of the study.

"The perception that managed care plans withhold expensive services from their members is not supported by our research," said Stafford. "While there may be areas where this phenomenon operates, it appears not to have been the case with chronic disease medications."

The authors of the study analyzed 1997 claims data from three independent practice organization-model managed care plans and two indemnity insurance plans in the Northeast. Using the health plans' medical claims, researchers identified all patients in the plans with diabetes (26,444 patients), heart failure (7,978) or asthma (9,850). The researchers then determined how many of these patients had filled at least one prescription for one of 18 medications or medication classes used to manage these diseases. Finally, researchers compared the use of these medications by patients in the managed care plans with those in the indemnity plans.

Even after adjusting for age, acuity and other factors, researchers found managed care patients significantly more likely to have received most of the medications.

"Almost across the board, we found that the managed care patients were more likely to receive these medications," Stafford said. Researchers concluded that the most likely explanation is that the managed care patients had lower out-of-pocket costs, and so were more likely to get prescriptions filled. And with their low co-payments for doctor visits, the managed care patients may have seen their doctors more often than the indemnity patients. PR

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