Implementation of the Medicare Part D Prescription Drug Benefit is Associated with Antiretroviral Therapy Interruptions
Identifieur interne : 000558 ( Ncbi/Merge ); précédent : 000557; suivant : 000559Implementation of the Medicare Part D Prescription Drug Benefit is Associated with Antiretroviral Therapy Interruptions
Auteurs : Moupali Das-DouglasSource :
- AIDS and behavior [ 1090-7165 ] ; 2008.
Abstract
Antiretroviral (ARV) treatment interruptions are associated with virologic rebound, drug resistance, and increased morbidity and mortality. The Medicare Part D prescription drug benefit, implemented on January 1st, 2006, increased consumer cost-sharing. Consumer cost-sharing is associated with decreased access to medications and adverse clinical outcomes. We assessed the association of Part D implementation with treatment interruptions by studying 125 HIV-infected homeless and marginally housed individuals with drug coverage receiving ARV therapy. Thirty-five percent of respondents reported Medicare coverage and 11% reported ARV interruptions. The odds of ARV interruptions were six times higher among those with Part D coverage and remained significant after adjustment. The majority of Part D-covered respondents reporting ARV interruptions cited increased cost as their primary barrier. Directed interventions to monitor the long-term effects of increased cost burden on interruptions and clinical outcomes and to reduce cost burden are necessary to avoid preventable increases in morbidity and mortality.
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DOI: 10.1007/s10461-008-9401-5
PubMed: 18483850
PubMed Central: 3591735
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<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9712133</journal-id><journal-id journal-id-type="pubmed-jr-id">21042</journal-id><journal-id journal-id-type="nlm-ta">AIDS Behav</journal-id><journal-id journal-id-type="iso-abbrev">AIDS Behav</journal-id><journal-title-group><journal-title>AIDS and behavior</journal-title></journal-title-group><issn pub-type="ppub">1090-7165</issn><issn pub-type="epub">1573-3254</issn></journal-meta><article-meta><article-id pub-id-type="pmid">18483850</article-id><article-id pub-id-type="pmc">3591735</article-id><article-id pub-id-type="doi">10.1007/s10461-008-9401-5</article-id><article-id pub-id-type="manuscript">NIHMS447651</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Implementation of the Medicare Part D Prescription Drug Benefit is Associated with Antiretroviral Therapy Interruptions</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Das-Douglas</surname><given-names>Moupali</given-names></name></contrib><aff id="A1">Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff><aff id="A2">Center for AIDS Prevention Studies, University of California, San Francisco, CA 94105, USA</aff><aff id="A3">HIV Prevention Section, AIDS Office, San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA 94102, USA</aff><aff id="A4">Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff><aff id="A5">Positive Health Program, San Francisco General Hospital, University of California, San Francisco, CA 94143, USA</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Riley</surname><given-names>Elise D.</given-names></name></contrib><aff id="A6">Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Ragland</surname><given-names>Kathleen</given-names></name></contrib><aff id="A7">Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Guzman</surname><given-names>David</given-names></name></contrib><aff id="A8">Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Clark</surname><given-names>Richard</given-names></name></contrib><aff id="A9">Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Kushel</surname><given-names>Margot B.</given-names></name></contrib><aff id="A10">Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94143, USA</aff></contrib-group><contrib-group><contrib contrib-type="author"><name><surname>Bangsberg</surname><given-names>David R.</given-names></name></contrib><aff id="A11">Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff><aff id="A12">Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious Diseases, University of California, San Francisco, CA 94143, USA</aff><aff id="A13">Positive Health Program, San Francisco General Hospital, University of California, San Francisco, CA 94143, USA</aff></contrib-group><author-notes><corresp id="CR1"><email>moupali.das-douglas@ucsf.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>26</day><month>2</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>16</day><month>5</month><year>2008</year></pub-date><pub-date pub-type="ppub"><month>2</month><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>08</day><month>3</month><year>2013</year></pub-date><volume>13</volume><issue>1</issue><fpage>1</fpage><lpage>9</lpage><permissions><copyright-statement>© Springer Science+Business Media, LLC 2008</copyright-statement><copyright-year>2008</copyright-year></permissions><abstract><p id="P1">Antiretroviral (ARV) treatment interruptions are associated with virologic rebound, drug resistance, and increased morbidity and mortality. The Medicare Part D prescription drug benefit, implemented on January 1st, 2006, increased consumer cost-sharing. Consumer cost-sharing is associated with decreased access to medications and adverse clinical outcomes. We assessed the association of Part D implementation with treatment interruptions by studying 125 HIV-infected homeless and marginally housed individuals with drug coverage receiving ARV therapy. Thirty-five percent of respondents reported Medicare coverage and 11% reported ARV interruptions. The odds of ARV interruptions were six times higher among those with Part D coverage and remained significant after adjustment. The majority of Part D-covered respondents reporting ARV interruptions cited increased cost as their primary barrier. Directed interventions to monitor the long-term effects of increased cost burden on interruptions and clinical outcomes and to reduce cost burden are necessary to avoid preventable increases in morbidity and mortality.</p></abstract><kwd-group><kwd>HIV/AIDS</kwd><kwd>Medicare</kwd><kwd>Adherence</kwd><kwd>Treatment interruption</kwd><kwd>Cost-sharing</kwd><kwd>Cost-related medication nonadherence</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute of Mental Health : NIMH</funding-source><award-id>R01 MH054907 || MH</award-id></award-group></funding-group></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Das Douglas, Moupali" sort="Das Douglas, Moupali" uniqKey="Das Douglas M" first="Moupali" last="Das-Douglas">Moupali Das-Douglas</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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