Pharmacy Benefit Caps and the Chronically Ill

Published in: Health Affairs, v. 26, no. 5, Sep./Oct. 2007, p. 1333-1343

Posted on RAND.org on January 01, 2007

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

Read More

Access further information on this document at content.healthaffairs.org

This article was published outside of RAND. The full text of the article can be found at the link above.

In this paper the authors examine medication use among retirees with employer-sponsored drug coverage both with and without annual benefit limits. The authors 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, the authors make some inferences about reforms for Medicare.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.