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The Effect of Insurance Coverage Changes on Drug Utilization in HIV Disease

Smith Scott R.; Kirking, Duane M.
JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2001
Articles: PDF Only

Background:Insurance coverage facilitates access to life-saving medications for many patients with HIV disease. Thus, the effects of insurance coverage changes, such as the gain or loss of coverage, may be important in explaining patient access and adherence to the medications used in the treatment of HIV disease.

Objectives:The study's objective was to examine whether changes in health insurance coverage affect rates of prescription drug use by patients with HIV disease.

Methods:Data were ascertained from adults participating in a series of up to six interviews as part of the AIDS Costs and Services Utilization Survey (ACSUS). ACSUS was an 18-month panel survey of patients in care for HIV/AIDS at 26 sites located in 10 U.S. cities. Poisson regression analyses with generalized estimating equations were conducted to determine the effects of demographic and socioeconomic variables on the acquisition rate of antiretrovirals, antipneumocystics, and antidepressants. The analytic sample consisted of 1566 respondents who provided 6518 interviews.

Results:Although changes in insurance coverage were common, complete loss of insurance was reported in only 1.5% of the interviews whereas gaining insurance was reported in 3.3% of interviews. Having no coverage was associated with significantly lower rates of antiretroviral (rate ratio [RR], 0.73), antipneumocystic (RR, 0.58) and antidepressant use (RR, 0.31). Gaining insurance coverage was associated with lower antiretroviral (RR, 0.75) and antipneumocystic (RR, 0.70) use whereas losing insurance was associated with lower antiretroviral use (RR, 0.58). In multivariate analyses, these associations remained.

Conclusions:Changes in health insurance coverage are associated with lower rates of drug use for some medications used by patients with HIV disease.

Address correspondence and reprint requests to Scott R. Smith, Division of Pharmaceutical Policy and Evaluative Sciences, 205 Beard Hall, Campus Box #7360, Chapel Hill, NC 27599-7360 U.S.A.; e-mail:

Manuscript received July 31, 2000; accepted June 28, 2001.

© 2001 Lippincott Williams & Wilkins, Inc.