Study: Insurance coverage, not need, drives drug use

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High-risk enrollees' access to proper prescriptions may be at risk if the Medicare program doesn't manage drug utilization better to prevent improper use of some drugs, according to an article posted to the Health Affairs Web site today.

Seniors with the most generous drug coverage were more likely than those with no or limited coverage to use the most costly pain medication for osteoarthritis, even when less expensive over-the-counter drugs could be substituted, according to a study on which the article is based.

Study authors said that higher-price drugs such as COX-2 inhibitors (brand names Celebrex and Vioxx) are no more effective as painkillers than over-the-counter medications such as ibuprofen. The over-the-counter drugs are, however, more likely to cause gastrointestinal problems, so COX-2 inhibitors are used with patients who are at risk for gastrointestinal bleeding and ulcers.

"While drug coverage is clearly associated with greater use of expensive COX-2 inhibitors, most of the increase in use is among those least in need," said Jalpa Doshi, a researcher from the University of Pennsylvania's Division of General Internal Medicine. "Our study suggests that policymakers should also be concerned with potential overuse of drug therapy by Medicare beneficiaries once the benefit is implemented."

If coverage leads to overuse of more expensive prescription drugs when the first-ever Medicare prescription drug benefit starts in 2006, Medicare could experience unexpectedly high costs without a corresponding improvement in health care quality and outcomes, Doshi said. However, the Medicare prescription drug benefit should also help those beneficiaries who need the more expensive drugs to obtain the appropriate medications, he added.