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Prescribed medicines: a comparison of FFS with HMO enrollees.

The Medicare Current Beneficiary Survey (MCBS) is a powerful tool for analyzing enrollees' access to medical care (Adler, 1994). Based on a stratified random sample, we can derive information about the health care use, expenditure, and financing of Medicare's 36 million enrollees. We can also learn about those enrollees' health status, living arrangements, and access to and satisfaction with care.

In the charts that follow, we have presented some findings on variations in the use of prescribed medicines by Medicare fee-for-service (FFS) and health maintenance organization (HMO) enrollees.

* HMO and FFS beneficiaries have roughly the same user rates.

* HMO enrollees pay slightly more than one-half that of their FFS counterparts on out-of-pocket prescription drug expenditures.

* Of the top ten prescribed medications within FFS and HMO, FFS beneficiaries reported only one generic medicine, while their HMO counterparts reported three generics, including the most frequently cited drug.

* The top ten FFS drugs represent 17.2 percent of all FFS mentions and 17.9 percent of FFS drug expenditures. The top ten HMO drugs represent 19.9 percent of all mentions and 17.3 percent of expenditures.

[ILLUSTRATIONS OMITTED]

Generic Versus Brand-Name Drug Usage Among FFS and HMO Beneficiaries
Drug FFS Mentions Drug HMO Mentions

Lanoxin 11,040,029 FUROSEMIDE 765,020
Cardizem 7,279,562 Lanoxin 738,471
Procardia 6,848,458 Vasotec 580,145
Zantac 6,775,104 Cardizem 545,495
FUROSEMIDE 6,190,546 HCTZ(**) 496,224
Lasix 6,000,161 Procardia 479,228
Vasotec 5,992,800 Premarin 413,688
Synthroid 5,697,207 Synthroid 402,307
Capoten 5,500,437 ISOSORBIDE DN 401,875
Premarin 5,131,864 Ventolin 386,878


NOTES: HCTZ is Hydrochlorothiazide. Include, all beneficiaries who did not receive care from both FFS and Medicare HMOs during the year. Dual eligibles and those in institutions have been excluded from the analysis. Numbers may not add to totals due to rounding. Figures do not account for non-respondents. Drug names incapable indicate generic. One mention equates to one container of a given medication. Does not include any drugs classified as "untranslatable" due to unrecognizable spellings.

SOURCE: Health Care Financing Administration, Office of the Actuary: Medicare Current Beneficiary Survey.

REFERENCE

Adler, G.: A Profile of the Medicare Current Beneficiary Survey. Health Care Financing Review 15(4):153-163, Summer 1994.

The authors are with the Office of the Actuary, Health Care Financing Administration. The opinions expressed are those of the authors and do not necessarily reflect those of the Health Care Financing Administration.

Reprint Requests: John A. Poisal, Health Care Financing Administration, Office of the Actuary, 7500 Security Boulevard, N-3-03-13, Baltimore, Maryland 21244-1850.
COPYRIGHT 1996 U.S. Department of Health and Human Services
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Service Delivery in an Evolving Managed Care Environment; fee-for-service
Author:Eppig, Franklin J.; Poisal, John A.
Publication:Health Care Financing Review
Date:Jun 22, 1996
Words:434
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