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Use of Medicare HMOs Tied to Drug Benefits

Wed, 01/10/2001 - 12:00am — Karen Stevenson
Description: 

Seniors who use up their prescription drug benefits are far more likely to drop their HMO coverage, according to research by Express Scripts Inc., one of the nation's largest pharmacy benefit managers (PBMs). The study confirms results of a earlier report by researchers at UnitedHealth Group, a Minneapolis, Minnesota-based managed care company, that linked Medicare HMO disenrollment to the exhaustion of drug benefits.

Although researchers concede that other forces may have factored into seniors' decisions to drop out of their HMOs, the study results suggest that drug caps do indeed sway enrollees' thinking in the matter. "What we found is that the relative risk of disenrollment is two to three times greater for those whose annual prescription drug costs exceed the coverage limits of their plan," Dr. Cox noted. "This finding held true, no matter how the plan was administered."

A synopsis of the study by Dr. Cox and colleagues at Express Scripts appears in a letter to the editor in the November 22/29 issue of The Journal of the American Medical Association.

Seniors who use up their prescription drug benefits are far more likely to drop their HMO coverage, according to research by Express Scripts Inc., one of the nation's largest pharmacy benefit managers (PBMs). The study confirms results of a earlier report by researchers at UnitedHealth Group, a Minneapolis, Minnesota-based managed care company, that linked Medicare HMO disenrollment to the exhaustion of drug benefits.

Although researchers concede that other forces may have factored into seniors' decisions to drop out of their HMOs, the study results suggest that drug caps do indeed sway enrollees' thinking in the matter. "What we found is that the relative risk of disenrollment is two to three times greater for those whose annual prescription drug costs exceed the coverage limits of their plan," Dr. Cox noted. "This finding held true, no matter how the plan was administered."

A synopsis of the study by Dr. Cox and colleagues at Express Scripts appears in a letter to the editor in the November 22/29 issue of The Journal of the American Medical Association.