Applying the 2003 Beers update to Medicaid/Medicare enrollees
The Authors
Steven A. Blackwell, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
Gary M. Ciborowski, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
David K. Baugh, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
Melissa A. Montgomery, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
Acknowledgements
The authors are with the Office of Research, Development, and Information, Centers for Medicare and Medicaid Services (CMS). This research is internally funded. The views and opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the CMS. The authors received input and guidance from Bill Clark, Penny Mohr, and Dan Waldo in the development of this paper. The paper was substantially improved by the contributions of these individuals.
Abstract
Purpose – The purpose of this paper is to examine rates of potentially inappropriate prescribing in a population dually eligible for Medicare and Medicaid using the new 2003 Fick update, which revises the previous 1997 Beers list.
Design/methodology/approach – Cross sectional retrospective review of 2003 Centers for Medicare and Medicaid Service (CMS) Medicaid Pharmacy claims data. Claims data submitted for outpatient and nursing home residents for elderly enrollees dually eligible for Medicare and Medicaid were analyzed. Potentially inappropriate drug use was assessed using the 2003 Fick update to the previous 1997 Beers list. Inappropriate use was identified based on these criteria for drugs independent of diagnosis.
Findings – Of enrollees with drug use, 34 percent received an inappropriate drug per the 1997 Beers list; 47 percent per the 2003 Fick update. Hispanics had the highest percentage of drug recipients receiving an inappropriate drug in the Northeast region per the 2003 Fick update. Within therapeutic category, the number of inappropriate genitourinary products dispensed to total genitourinary products ranked the highest at 20 percent per the 2003 Fick update.
Practical implications – This study examines variations in Beers drug use in the elderly dually eligible Medicare and Medicaid population in 2003 by applying the 2003 Fick et al. update of the 1997 Beers list to one of the nation's largest sources of person-specific data on prescribed drugs. Inappropriate use was identified for drugs independent of diagnosis. Of enrollees with drug use, 34 percent received an inappropriate drug per the 1997 Beers list; 47 percent per the 2003 Fick update. Within therapeutic category, the number of inappropriate genitourinary products dispensed to total genitourinary products ranked the highest at 20 percent per the 2003 Fick update. The paper's findings provide evidence that the potential use of inappropriate drugs in Hispanics should be considered separately from other ethnicity groups.
Originality/value – A markedly higher rate of potentially inappropriate drug use in the elderly Medicaid population exists following the Fick update. These findings provide evidence that the potential use of inappropriate drugs in Hispanics should be considered separately from other ethnicity groups. By comparing drug use based on therapeutic category, genitourinary products were found to have the highest potential for inappropriate prescribing.
Article Type:
Research paper
Keyword(s):
United States of America; Medical prescriptions; Patient care; Elderly people; Health insurance.
Journal:
International Journal of Pharmaceutical and Healthcare Marketing
Volume:
2
Number:
4
Year:
2008
pp:
257-272
Copyright ©
Emerald Group Publishing Limited
ISSN:
1750-6123
Introduction
The inappropriate use of prescription medications is particularly harmful to the elderly (General Accounting Office (GAO), 1995). As early as 1991 efforts were made to enumerate the most egregious prescription drugs so that the medical community could take special care when prescribing the drugs considered most harmful. This inventory of drugs generally recognized as harmful for the elderly, the “Beers Drugs,” has captured the attention of researchers for nearly two decades.
What exactly is a “Beers drug” and what is its medical significance for an elderly patient? A Beers drug is a prescription medication which medical experts have determined has a potential risk for an adverse outcome that outweighs its potential benefit (Fick et al., 2003). Examples of adverse outcomes include unwanted central nervous system (CNS), cardiovascular, and renal effects. Because of the elevated medical risks associated with these particular medications, their use should generally be avoided in the elderly population. The Beers drug list includes certain sedatives and hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory drugs, oral hypoglycemics, and analgesics. Example drugs include propoxyphene, diazepam, amitriptyline, and carisoprodol. This list is based on expert consensus developed through an extensive literature review with a bibliography and questionnaire evaluated by nationally recognized experts in geriatric care, clinical pharmacology, and psychopharmacology using a modified Delphi technique to reach consensus. The use of consensus criteria for safe medication use is a widely accepted approach to developing reliable and explicit criteria when precise clinical information is lacking (Fick et al., 2003). In the elderly population, the Beers drugs list is an established and widely accepted consensus criterion for medication use (Beers, 1997).
For all the medications listed in the Beers drug list better therapeutic options exist. However, it should be noted, that the use of a Beers drug may be justified in some circumstances when the benefits outweigh the risks for an individual patient.
We shall define, then, “the Beers drugs” as an explicit list of medications that the medical community suggests elderly persons should avoid. Beers drugs should generally be avoided because, in the elderly, the potential for adverse outcomes is greater than the potential for benefit (Doucet et al., 1996; Golden et al., 1999; Mort and Aparasu, 2000; Smalley and Griffin, 1996). Utilized since 1991, this list of medications has been used to survey clinical medication use, analyze computerized administrative data and evaluate intervention studies designed to decrease medication problems in older adults. In 1999, the Beers list was adopted by the Centers for Medicare and Medicaid Services (CMS) for nursing home regulation (Briesacher et al., 2005).
Previous studies on Beers drugs have been conducted for nursing home patients, home health care Medicare beneficiaries, Medicare HMO beneficiaries, the community-dwelling elderly, Emergency Department patients, and the Medicaid population (Golden et al., 1999; Liu and Christensen, 2002; Meredith et al., 2001; Mott and Meek, 2000). What continues to fuel interest in prescription drug use by the elderly? Why focus on this specific demographic group? The answer, simply stated, is that the elderly use more prescription drugs than any other age group and are more susceptible to adverse drug reactions because of the aging process.
With age, pharmacokinetics – how the body absorbs, metabolizes and eliminates a drug – and pharmacodynamics – what a drug does to the body – change. Because of these interactions, certain medications while appropriate for younger patients may not be appropriate for the elderly. As important, the use of prescription drugs increases with age as older adults wrestle with the burden of chronic disease.
In addition to using prescribed medications, older adults use other products ubiquitously, including over-the-counter drugs, herbal remedies, and dietary supplements such as vitamins and minerals. Physicians have an especially difficult problem when considering the plethora of substances taken by the elderly. A “prescribing cascade” can occur – the side effects of one or more medications can be interpreted as a new symptom that gets treated with yet another drug instead of being recognized as side effects of existing medications. Current research indicates that at least 85 percent of the elderly use one prescription drug, and most use more than one (Ihara et al., 2002). A GAO analysis of 1992 data from CMS's Medicare Current Beneficiary Survey found that approximately 17.5 percent of Medicare recipients 65 or older used at least one drug identified as generally unsuitable for elderly patients (General Accounting Office, 1995). The study addressed Beers drug use in proportion to all recipients whether or not recipients received medications. A more recent study using a single state's Medicaid pharmacy claims data for elderly recipients found that 27 percent of the study's population received a potentially inappropriate drug (Piecoro et al., 2000). The study addressed Beers drug use in proportion to recipients who had received medications.
At present, the current Beers list has been updated by Fick et al. to include several medications that have new information or have come to market since the last update of the Beers drugs in 1997 (Fick et al., 2003). The current study is one of the first studies to employ this new update. Fick et al. added such drugs as methyltestosterones, amphetamines, and bupropion hydrochloride to the list of medications to be avoided in the elderly. In total, 25 medications or medication classes independent of diagnoses were added to the previous 1997 Beers list. This study, using the Fick et al. update, is expected to find higher levels of Beers drug utilization than previous studies that used the prior 1997 Beers list which included fewer drugs in its compendium.
Methodology
Descriptive analyses (population parameter assessments) were conducted on selected 2003 Medicaid analytic extract (MAX) files which contain beneficiary-level utilization data on a calendar year basis (Centers for Medicare & Medicaid Services, 2008). The MAX files are a set of person-level data files derived from the Medicaid Statistical Information System data on Medicaid eligibility, service utilization and payments. The data are available for all states and the District of Columbia beginning with calendar year 1999. The data are available for selected states prior to 1999. These data are developed to support research and policy analysis initiatives for Medicaid and other low-income populations.
A cross-sectional design was employed to perform the study for 50 states and the District of Columbia using the 2003 MAX data. Data extracted from the MAX files contain paid pharmacy claims for patients at the time the prescriptions were dispensed.
CMS associated its National Drug Code data (resident in its prescription drug claims database) with drug names from the 2003 Medi-Span therapeutic classification system (Wolters Kluwer Health, 2008) to obtain the names and therapeutic categories of the drugs used in this paper. Permission to use the proprietary information from Medi-Span is granted to CMS for its internal research under special license.
The Beers criteria used in this study were the criteria addressed by the Fick et al. update (Fick et al., 2003). Patients who received any drug defined by Fick et al. as being potentially inappropriate independent of diagnoses or conditions were classified as having inappropriate use. Dose limited drugs were not included in the analysis. Our current analysis will serve as a baseline evaluation of the use of all drugs deemed potentially inappropriate in a pre-Medicare Part D environment.
The study population addresses elderly dually eligible Medicare and Medicaid beneficiaries who were 65 years old or older (as of December 31, 2003) in the 50 states and DC. The data used for this study excluded drugs used during acute inpatient stays and, in a few states, excluded drugs provided in a long-term setting. Beneficiaries who were eligible for at least one month in 2003 were included. Eligibility applies to those:
- continuously eligible throughout the year;
- initially eligible after January;
- who lost and regained eligibility during the year; and
- who lost and did not regain eligibility.
Typically, eligibility for Medicaid is determined on a monthly basis, and beneficiaries gain or lose Medicaid eligibility for many reasons. The extent of this on/off eligibility (known as “churning”) varies by a person's eligibility group and age. Dually eligible beneficiaries may lose eligibility for a number of reasons including medical improvements in a previously disabling condition, receipt of Social Security cash benefits, or death. Because a beneficiary may have received drugs in more than one Beers classification, the number of recipients of Beers drugs may be less than the sum of the number of recipients across the Beers drugs classifications.
Findings
Study population
Our study population was comprised of 5,412,678 dually eligible Medicaid beneficiaries irrespective of drug use (Table I). The South region had the largest proportion of beneficiaries followed by the West region and the Midwest region. The Northeast region had the lowest proportion of beneficiaries. Based on age, the 65-74 age group had the highest proportion of beneficiaries followed by the 75-84 age group. The 85 and over age group had the lowest proportion of dually eligible beneficiaries. Based on gender, 71 percent of our study population was female. Caucasian Americans comprised the largest proportion of our study population followed by African Americans. Hispanic Americans comprised the lowest proportion of our study population. Dually eligible Medicaid beneficiaries that were drug recipients comprised over 71 percent of our study population (Table II).
1997 Beers list recipients
Based on the 1997 Beers list, over 24 percent of our population received at least one Beers drug in 2003 (Tables I and III); approximately 34 percent when using the denominator based on recipients that received a medication during the study period (Table II). The South region had the largest proportion of beneficiaries receiving at least one Beers drug, followed by the West region and the Midwest region. The Northeast region had the lowest proportion of beneficiaries receiving at least one Beers drug. Based on age, the 65-74 age group had the highest proportion of Beers recipients followed by the 85 and over age group. The 75-84 age group had the lowest proportion of beneficiaries receiving at least one Beers drug. Based on gender, females received more Beers drugs than males. Caucasian Americans had the largest proportion of beneficiaries receiving at least one Beers drug followed by Hispanic Americans (when excluding the “other” group). African Americans had the lowest proportion of beneficiaries receiving at least one Beers drug.
1997 Beers list prescriptions
In 2003, there were over 6 million prescriptions filled for Beers drugs in the elderly dually-eligible Medicaid population based on the 1997 Beers list (Table III). This constituted approximately 3 percent of all prescriptions filled (Tables II and III). As with the proportion of beneficiaries receiving Beers drugs based on the 1997 Beers list, the South region had the highest proportion of filled Beers prescriptions at 4.12 percent. However, the Midwest region had the second highest proportion of filled Beers prescriptions followed by the West region (3.06 and 2.72 percent, respectively). The Northeast region had the lowest proportion at 2.18 percent. Based on age, the 65-74 age group had the highest proportion of prescriptions filled for Beers drugs followed by the 75-84 age group (3.62 and 3.10 percent, respectively). The 85 and over age group had the lowest proportion of prescriptions filled for Beers drugs at 2.81 percent. Based on gender, females filled almost four times as many Beers prescriptions as compared to males. By proportion, 3.40 percent of all prescriptions filled for females were for a Beers drug. By proportion 2.71 percent of all prescriptions filled for males were for a Beers drug. By race and ethnicity, Caucasian Americans had the largest proportion of filled Beers prescriptions followed by African Americans (3.38 and 3.20 percent, respectively). Hispanic Americans had the lowest proportion of filled Beers prescriptions at 2.63 percent (when excluding the “other” racial group within the race and ethnic category). Across drug categories, the category genitourinary products had the highest proportion of filled Beers prescriptions followed by the category analgesics/anesthetics (21.01 and 9.00 percent, respectively) (Tables IV and V). The drug category endocrine/metabolic drugs had the lowest proportion of filled Beers prescriptions at 0.09 percent.
2003 Fick et al. update recipients
Based on the Fick et al. update, over 33 percent of our population received at least one Fick criteria drug in 2003 (Tables I and VI); approximately 47 percent when using the denominator based on recipients that received a medication during the study period (Table II). The South region had the largest proportion of beneficiaries receiving at least one Fick drug, followed by the West region and the Midwest region. The Northeast region had the lowest proportion of beneficiaries receiving at least one Fick drug. Based on age, the 65-74 age group had the highest proportion of Fick recipients followed by the 75-84 age group. The 85 and over age group had the lowest proportion of beneficiaries receiving at least one Fick drug. Based on gender, females received more Fick drugs than males. Hispanic Americans had the largest proportion of beneficiaries receiving at least one Fick drug (on excluding the “other” category) followed by Caucasian Americans. African Americans had the lowest proportion of beneficiaries receiving at least one Fick drug.
2003 Fick et al. update prescriptions
In 2003, there were over 11.5 million prescriptions filled for Fick drugs in the elderly dually-eligible Medicaid population (Table VI). This constituted approximately 5.5 percent of all prescriptions filled (Tables II and VI). As with the proportion of beneficiaries receiving Fick drugs, the South region had the highest proportion of filled Fick prescriptions at 6.79 percent. The West region had the second highest proportion of filled Fick prescriptions followed by the Midwest region (5.43 and 4.93 percent, respectively). The Northeast region had the lowest proportion at 3.74 percent. Based on age, the 65-74 age group had the highest proportion of prescriptions filled for Fick drugs followed by the 75-84 age group (6.31 and 5.28 percent, respectively). The 85 and over age group had the lowest proportion of prescriptions filled for Fick drugs at 4.60 percent. Based on gender, females filled approximately three and one-half (3 1/2) times as many Fick prescriptions as compared to males. By proportion, 5.71 percent of all prescriptions filled for females were for a Fick drug. By proportion, 4.88 percent of all prescriptions filled for males were for a Fick drug. By race and ethnicity, African Americans had the largest proportion of filled Fick prescriptions followed by Caucasian Americans (5.81 and 5.62 percent, respectively). Hispanic Americans had the lowest proportion of filled Fick prescriptions at 4.76 percent. Across drug categories, the category genitourinary products had the highest proportion of filled Fick prescriptions followed by the category CNS drugs (19.65 and 12.24 percent, respectively) (Tables IV and VII). The drug category hematological agents had the lowest proportion of filled Fick prescriptions at 1.40 percent.
Discussion
In this study, we examine variations in Beers drug use in the elderly dually eligible Medicare and Medicaid population using the 2003 Fick et al. update of the 1997 Beers list. This study is one of the first to employ this new update. We use similar methods employed in previous studies to determine the extent to which the utilization of Beers drugs in the elderly Medicaid dually eligible population differs from that of previously examined populations based on these new criteria.
Our findings agree with some findings of previously studied populations which used the prior 1997 Beers list. A previous study of the VA population using administrative claims data found that the younger aged are more likely to receive Beers drugs as compared to the older aged (Pugh et al., 2005). Using the Fick et al. update, we found that the 65-74 age group had the highest percentage of Beers drug recipients followed by the 75-84 age group and the 85 and over age group (Tables I and VI). Our results reveal an elderly Medicaid dually eligible population that is largely female; this contrasts noticeably with the VA study of 1,265,434 veterans aged 65 and over, 98 percent of which were male (Pugh et al., 2005). In our elderly Medicaid dually eligible population, 70.7 percent of all recipients were female.
Previous research has found that the rate of inappropriate drug use varies from 14 percent in the community-dwelling elderly to 40.3 percent in nursing home residents (Pugh et al., 2005; Aparasu and Mort, 2000; Zhan et al., 2001; Goulding, 2004). A 1996 study by Piecoro et al. utilized Medicaid pharmacy claims data for elderly patients and found that 27 percent of the study's population received a potentially inappropriate drug (Piecoro et al., 2000). The Piecoro et al. analysis used recipients that received a medication during the study period as their denominator. As in our study, drug claims for nursing home patients were included in the Piecoro et al. analysis. However, using this same denominator (i.e. recipients that received a medication during the study period as the denominator) and applying the 2003 Fick et al. update, we found that approximately 47 percent of our population utilized a Beers drug (Tables II and VI). It is worth noting that when comparing the 1997 Beers list to the 2003 Fick et al. update, we found that filled prescriptions for Beers agents increased by 70 percent following the Fick et al. update (Table VIII). As shown in Table VIII, the largest increase in filled prescriptions (following the Fick et al. update) occurred with endocrine/metabolic drugs followed by cardiovascular agents (5,135 and 2,013 percent, respectively). Thus, as expected, the Fick et al. update allowed us to document a higher use of Beers drugs within the elderly dually eligible enrollee Medicaid population as compared to the 1997 Beers list. These findings suggest that a higher probability of associated adverse events with Beers drug use may exist than previously suspected. Future research needs to address the trending of Beers drug use in the Medicaid population.
We found that Hispanic Americans have the lowest utilization of Beers drugs when comparing the percentage of recipients with Beers drug use to the denominator of beneficiaries that received a medication during the study period for the 2003 Fick et al. update (Tables II and VI). However, by using a different denominator based on all eligible Medicaid individuals irrespective of drug use (i.e. whether or not the individual received a medication during the study period), we found that Hispanic Americans had the highest utilization of Beers drugs based on the 2003 Fick et al. update (Tables I and VI). A previous study found that older Mexican Americans were less likely to receive Beers drugs and hypothesized that this was due to less healthcare use by Mexican Americans (Raji et al., 2003). However, based on the present findings using a slightly different denominator, stronger evidence exists supporting the idea that the use of Beers drugs in Hispanic Americans should be considered separately from other ethnicity groups. Thus, a clear need exists to examine Beers drug use using different denominators in order to assist policy decisions.
As addressed previously, other studies suggest that Caucasian Americans are more likely to receive Beers drugs than other ethnic groups. Our findings, however, indicate that by using the Fick et al. update, Beers drug use in the African American population more closely approximates the use of Beers drugs in Caucasian Americans (Tables II and VI). This finding remained true regardless of whether the denominator used for the comparison was:
- Recipients that received a medication during the study period or.
- All eligible individuals irrespective of drug use (Tables I, II, and VI).
For example, our findings show that African Americans had the largest proportion of filled Fick prescriptions when the denominator of recipients that received a medication during the study period was employed. Thus, we suggest that the Caucasian American population may no longer be the predominant population for Beers drug use.
From a policy perspective, a challenging task is to identify potential risk factors associated with receiving inappropriate drugs (Liu and Christensen, 2002). By comparing Beers drug use based on drug category, we were able to frame a clearer picture of prescribing patterns associated with Beers drug use. Our results indicate that the drug category of genitourinary products has the highest use of Beers drugs within the elderly dually-eligible Medicaid population. Previous studies have consistently found that the most commonly prescribed drugs are CNS agents and/or analgesics/anesthetics (Piecoro et al., 2000; Zhan et al., 2001; Goulding, 2004; Hanlon et al., 2002; Fick et al., 2001; Willcox et al., 1994). Such agents include pain relievers, psychotropic drugs, and muscle relaxants. We also found that CNS drugs were the most dispensed medications followed by analgesics/anesthetics (Table IV). However, when considering within category use, the proportion of Beers genitourinary products dispensed to total genitourinary products was approximately 21 percent (compared to 7.94 percent for CNS drugs and 9.00 percent for analgesics/anesthetics) based on the 1997 Beers list and approximately 20 percent (compared to 12.24 percent for CNS drugs and 12.20 percent for analgesics/anesthetics) based on the 2003 Fick et al. update (Table IV). This finding suggests that if a patient is presented to the prescriber with a need for a genitourinary product, the chance that a Beers drug genitourinary product will be prescribed is greater than for any other Beers drug category. Thus, a new focus in identifying patterns associated with the use of Beers drugs in the Medicaid population should be the use of genitourinary products in the elderly. Furthermore, this finding suggests that, for Medicaid patients, a clear need exists to examine the reasons for prescribing Beers drugs for the purpose of reducing the prescribing of Beers genitourinary products to the extent possible.
Further assessment of within-category use, allowed us to identify changes in drug utilization occurring between the 1997 Beers list and the 2003 Fick et al. update. The drugs Clonidine, Fluoxetine, Estrogens, Cimetadine, and Nitrofurantion replaced previous drugs as the most utilized for their respective therapeutic category based on the Fick et al. update. The drugs propoxyphene and cyclobenzaprine continued to retain their lead roles as the most utilized drugs in their respective therapeutic categories despite the addition of new drugs based on the Fick et al. update. It is striking that the drug Propoxyphene continued to remain the most utilized Beers drug of all Beers drugs following the 2003 Fick et al. update. Future research needs to address changes in outcomes associated with Beers drug use based on within-category use applying the 2003 Fick et al. update.
Conclusion
This study examined potentially inappropriate prescribing of harmful medications in the elderly dually eligible Medicaid population using the 2003 Fick et al. update to the 1997 Beers criteria. Based on the 2003 Fick update, 47 percent of elderly dually eligible Medicare and Medicaid drug recipients received potentially inappropriate drugs when using the denominator of recipients that received a medication during the study period. However, such use may be justified in some circumstances when the benefits outweigh the risks for an individual patient. Our findings also provide evidence that the potential use of inappropriate drugs in Hispanics should be considered separately from other ethnicity groups.
These findings suggest that there are risks of adverse events because of Beers prescribing to a large segment of the elderly dually eligible Medicaid population. Because of this, further research should be directed to examining the extent to which the use of these drugs is related to adverse outcomes for these elderly Medicaid enrollees. Additionally, we sometimes found differing results based on the construction of various denominators for evaluating the data. Thus, we suggest that Beers drug use should be evaluated using differing denominators in order to assist policy decisions.
We also see opportunities to improve prescribing behaviors of practitioners. By comparing Beers drug use based on therapeutic category, we were able to frame a clearer picture of prescribing patterns associated with Beers drug use. We found that genitourinary products have the highest potential for inappropriate prescribing.
Because CMS has implemented Medicare Part D (which provides coverage of prescribed drugs), the utilization of Beers drugs in Medicare should be re-examined once Part D data become available. Like unto Medicaid plans, Part D prescription drug plans have the ability to develop initiatives to address the inappropriate use of drugs among the elderly. They are also well suited to develop the necessary databases for engaging in outcomes research which, in turn, will be most useful in helping providers and payers make financially and clinically informed health care decisions.
Our results underscore the need for medical professionals, especially general practitioners, to become familiar with Beers drugs when treating the elderly so that potentially dangerous drug prescriptions can be eliminated. Since the age 65 and over age group population continues to grow, the elderly and their family advocates also need to familiarize themselves with the Beers drugs-bringing these studies to the attention of the health care providers they select, if necessary, to improve their own quality of life through informed consumption of prescription medications.
Table INumber of Medicaid enrolleesa by gender, age, group, origin, and region, for dual enrollees age 65 and over, 2003
Table IINumber of Medical recipients with drug usea and number of prescriptionsb by gender, age, group, origin, and region, for dual enrolles age 65 and over, 2003
Table IIINumber of Medicaid Beersa recipientsb and prescriptionsc based on the 1997 Beers listd by gender, age group, origin, and region, for dual enrollees age 65 and over, 2003
Table IVMedicaid Beersa and Medicaid Fickb filled prescriptions as a percentage of all filled prescriptionsc by therapeutic category, for dual enrollee recipients age 65 and over, 2003
Table VMedicaid Beersa filled prescriptionsb by therapeutic category and region, for dual enrollee recipients age 65 and over, 2003
Table VINumber of Medicated Ficka recipientsb and prescriptionsc by gender, age group, origin, and region, for dual enrollees age 65 and over, 2003
Table VIIMedicaid Ficka filled prescriptionsb by therapeutic category and region, for dual enrollees recipients age 65 and over, 2003
Table VIIIMedicaid utilization statistics for Beersa drugs and Fickb drugs by therapeutic category, for dual enrollee recipients age 65 and over 2003
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About the authors
Steven A. Blackwell, PhD, JD, RPh., is a Social Science Research Analyst, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA. Steven A. Blackwell is the corresponding author and can be contacted at: sblackwell@cms.hhs.gov
Gary M. Ciborowski, MA, is a Information Technology Specialist, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA.
David K. Baugh, MA, is Senior Technical Advisor, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA.
Melissa A. Montgomery, PhD, is an Economist, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA.