Pharmacy benefit caps and the chronically ill

Geoffrey F. Joyce, Dana P. Goldman, Pinar Karaca-Mandic, Yuhui Zheng

    Research output: Contribution to journalArticlepeer-review

    29 Scopus citations

    Abstract

    In this paper we examine medication use among retirees with employer-sponsored drug coverage both with and without annual benefit limits. We find that pharmacy benefit caps are associated with higher rates of medication discontinuation across the most common therapeutic classes and that only a minority of those who discontinue use reinitiate therapy once coverage resumes. Plan members who reach their cap are more likely than others to switch plans and increase their rate of generic use; however, in most cases, the shift is temporary. Given the similarities between these plans and Part D, we make some inferences about reforms for Medicare.

    Original languageEnglish (US)
    Pages (from-to)1333-1344
    Number of pages12
    JournalHealth Affairs
    Volume26
    Issue number5
    DOIs
    StatePublished - Sep 2007

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