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Pharmacy Benefit Caps And the Chronically Ill
Health Affairs (2007)
  • Geoffrey F. Joyce
  • Dana P. Goldman
  • Pinar Karaca-Mandic
  • Yuhui Zheng

In this paper we examine medication use among retirees with employersponsored 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.

  • benefit caps,
  • pharmacy benefit design
Publication Date
September 1, 2007
Citation Information
Geoffrey F. Joyce, Dana P. Goldman, Pinar Karaca-Mandic and Yuhui Zheng. "Pharmacy Benefit Caps And the Chronically Ill" Health Affairs Vol. 9 Iss. 1 (2007)
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