{"id":"https://openalex.org/W2040402812","doi":"https://doi.org/10.1001/jama.290.2.222","title":"Impact of an Annual Dollar Limit or \"Cap\" on Prescription Drug Benefits for Medicare Patients","display_name":"Impact of an Annual Dollar Limit or \"Cap\" on Prescription Drug Benefits for Medicare Patients","publication_year":2003,"publication_date":"2003-07-08","ids":{"openalex":"https://openalex.org/W2040402812","doi":"https://doi.org/10.1001/jama.290.2.222","mag":"2040402812","pmid":"https://pubmed.ncbi.nlm.nih.gov/12851277"},"language":"en","primary_location":{"id":"doi:10.1001/jama.290.2.222","doi":"https://doi.org/10.1001/jama.290.2.222","is_oa":false,"landing_page_url":"https://doi.org/10.1001/jama.290.2.222","pdf_url":null,"source":{"id":"https://openalex.org/S172573765","display_name":"JAMA","issn_l":"0002-9955","issn":["0002-9955","0098-7484","1538-3598","2376-8118"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320259","host_organization_name":"American Medical Association","host_organization_lineage":["https://openalex.org/P4310320259"],"host_organization_lineage_names":["American Medical Association"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JAMA","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://escholarship.org/content/qt5pw679fn/qt5pw679fn.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5017354513","display_name":"Chien\u2010Wen Tseng","orcid":"https://orcid.org/0000-0001-7162-2550","observed_orcids":["https://orcid.org/0000-0001-7162-2550"]},"institutions":[{"id":"https://openalex.org/I117965899","display_name":"University of Hawai\u02bbi at M\u0101noa","ror":"https://ror.org/01wspgy28","country_code":"US","type":"education","lineage":["https://openalex.org/I117965899"]},{"id":"https://openalex.org/I1331384533","display_name":"University of Hawaii System","ror":"https://ror.org/03tzaeb71","country_code":"US","type":"education","lineage":["https://openalex.org/I1331384533"]},{"id":"https://openalex.org/I4210150257","display_name":"Pacific Health Research and Education Institute","ror":"https://ror.org/05sshfw48","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210150257"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Chien-Wen Tseng","raw_affiliation_strings":["Department of Family Practice and Community Health, University of Hawaii, and Pacific Health Research Institute, Honolulu, USA. cwtseng@hawaii.edu"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Family Practice and Community Health, University of Hawaii, and Pacific Health Research Institute, Honolulu, USA. cwtseng@hawaii.edu","institution_ids":["https://openalex.org/I117965899","https://openalex.org/I1331384533","https://openalex.org/I4210150257"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5017354513"],"corresponding_institution_ids":["https://openalex.org/I117965899","https://openalex.org/I1331384533","https://openalex.org/I4210150257"],"apc_list":null,"apc_paid":null,"fwci":12.7622,"has_fulltext":true,"cited_by_count":48,"citation_normalized_percentile":{"value":0.98250709,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":88,"max":95},"biblio":{"volume":"290","issue":"2","first_page":"222","last_page":"222"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.8490999937057495,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.8490999937057495,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11792","display_name":"Pharmaceutical Economics and Policy","score":0.1340000033378601,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12708","display_name":"Economic and Financial Impacts of Cancer","score":0.004800000227987766,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/medicare-prescription-drug-benefit","display_name":"Medicare prescription drug benefit","score":0.6010000109672546},{"id":"https://openalex.org/keywords/medicare-advantage","display_name":"Medicare Advantage","score":0.6570000052452087},{"id":"https://openalex.org/keywords/out-of-pocket-drug-costs","display_name":"out-of-pocket drug costs","score":0.9139999747276306},{"id":"https://openalex.org/keywords/prescription-drug-spending","display_name":"prescription drug spending","score":0.7239999771118164},{"id":"https://openalex.org/keywords/chronic-disease","display_name":"chronic disease","score":0.4909999966621399},{"id":"https://openalex.org/keywords/generic-drugs","display_name":"generic drugs","score":0.7990000247955322},{"id":"https://openalex.org/keywords/pharmacy-claims-data","display_name":"pharmacy claims data","score":0.5379999876022339}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8750239610671997},{"id":"https://openalex.org/C2426938","wikidata":"https://www.wikidata.org/wiki/Q3355478","display_name":"Medical prescription","level":2,"score":0.8163676261901855},{"id":"https://openalex.org/C2778858636","wikidata":"https://www.wikidata.org/wiki/Q1643563","display_name":"Prescription drug","level":3,"score":0.7282721996307373},{"id":"https://openalex.org/C2776291444","wikidata":"https://www.wikidata.org/wiki/Q6806635","display_name":"Medicare Part D","level":4,"score":0.7217460870742798},{"id":"https://openalex.org/C109168655","wikidata":"https://www.wikidata.org/wiki/Q242988","display_name":"Liberian dollar","level":2,"score":0.6391357779502869},{"id":"https://openalex.org/C104863432","wikidata":"https://www.wikidata.org/wiki/Q614304","display_name":"Pharmacy","level":2,"score":0.5980653166770935},{"id":"https://openalex.org/C101864126","wikidata":"https://www.wikidata.org/wiki/Q7240896","display_name":"Prescription costs","level":4,"score":0.5102484226226807},{"id":"https://openalex.org/C2776680279","wikidata":"https://www.wikidata.org/wiki/Q5174821","display_name":"Cost sharing","level":2,"score":0.4506632089614868},{"id":"https://openalex.org/C145097563","wikidata":"https://www.wikidata.org/wiki/Q1148747","display_name":"Payment","level":2,"score":0.4445951581001282},{"id":"https://openalex.org/C2780035454","wikidata":"https://www.wikidata.org/wiki/Q8386","display_name":"Drug","level":2,"score":0.41616091132164},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.34691911935806274},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.3109229803085327},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.2562190294265747},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.1008317768573761},{"id":"https://openalex.org/C98274493","wikidata":"https://www.wikidata.org/wiki/Q128406","display_name":"Pharmacology","level":1,"score":0.09192276000976562},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D003363","descriptor_name":"Cost Control","qualifier_ui":"Q000331","qualifier_name":"legislation & jurisprudence","is_major_topic":false},{"descriptor_ui":"D003430","descriptor_name":"Cross-Sectional Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005102","descriptor_name":"Health Expenditures","qualifier_ui":"Q000331","qualifier_name":"legislation & jurisprudence","is_major_topic":false},{"descriptor_ui":"D005102","descriptor_name":"Health Expenditures","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D005382","descriptor_name":"Financing, Personal","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007356","descriptor_name":"Insurance, Pharmaceutical Services","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D008329","descriptor_name":"Managed Care Programs","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D011306","descriptor_name":"Prescription Fees","qualifier_ui":"Q000331","qualifier_name":"legislation & jurisprudence","is_major_topic":true},{"descriptor_ui":"D011307","descriptor_name":"Drug Prescriptions","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016527","descriptor_name":"Drug Costs","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017047","descriptor_name":"Cost Sharing","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D020398","descriptor_name":"Medicare Part C","qualifier_ui":"Q000331","qualifier_name":"legislation & jurisprudence","is_major_topic":true}],"locations_count":5,"locations":[{"id":"doi:10.1001/jama.290.2.222","doi":"https://doi.org/10.1001/jama.290.2.222","is_oa":false,"landing_page_url":"https://doi.org/10.1001/jama.290.2.222","pdf_url":null,"source":{"id":"https://openalex.org/S172573765","display_name":"JAMA","issn_l":"0002-9955","issn":["0002-9955","0098-7484","1538-3598","2376-8118"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320259","host_organization_name":"American Medical Association","host_organization_lineage":["https://openalex.org/P4310320259"],"host_organization_lineage_names":["American Medical Association"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JAMA","raw_type":"journal-article"},{"id":"pmid:12851277","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/12851277","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JAMA","raw_type":"Journal Article"},{"id":"pmh:oai:escholarship.org:ark:/13030/qt5pw679fn","doi":null,"is_oa":true,"landing_page_url":"https://escholarship.org/uc/item/5pw679fn","pdf_url":"https://escholarship.org/content/qt5pw679fn/qt5pw679fn.pdf","source":{"id":"https://openalex.org/S4306400115","display_name":"eScholarship (California Digital Library)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I2801248553","host_organization_name":"California Digital Library","host_organization_lineage":["https://openalex.org/I2801248553"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"JAMA: The Journal of the American Medical Association, vol 290, iss 2","raw_type":"article"},{"id":"pmh:oai:escholarship.org/ark:/13030/qt5pw679fn","doi":null,"is_oa":false,"landing_page_url":"https://escholarship.org/uc/item/5pw679fn","pdf_url":null,"source":{"id":"https://openalex.org/S4306400115","display_name":"eScholarship (California Digital Library)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I2801248553","host_organization_name":"California Digital Library","host_organization_lineage":["https://openalex.org/I2801248553"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"JAMA, vol 290, iss 2","raw_type":"article"},{"id":"pmh:qt5pw679fn","doi":null,"is_oa":false,"landing_page_url":"http://www.escholarship.org/uc/item/5pw679fn","pdf_url":null,"source":{"id":"https://openalex.org/S4306400115","display_name":"eScholarship (California Digital Library)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I2801248553","host_organization_name":"California Digital Library","host_organization_lineage":["https://openalex.org/I2801248553"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Tseng, CW; Brook, RH; Keeler, E; & Mangione, CM. (2003). Impact of an Annual Dollar Limit or \"Cap\" on Prescription Drug Benefits for Medicare Patients. Journal of the American Medical Association, 290(2), 222 - 227. doi: 10.1001/jama.290.2.222. UCLA: Retrieved from: http://www.escholarship.org/uc/item/5pw679fn","raw_type":"article"}],"best_oa_location":{"id":"pmh:oai:escholarship.org:ark:/13030/qt5pw679fn","doi":null,"is_oa":true,"landing_page_url":"https://escholarship.org/uc/item/5pw679fn","pdf_url":"https://escholarship.org/content/qt5pw679fn/qt5pw679fn.pdf","source":{"id":"https://openalex.org/S4306400115","display_name":"eScholarship (California Digital Library)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I2801248553","host_organization_name":"California Digital Library","host_organization_lineage":["https://openalex.org/I2801248553"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"JAMA: The Journal of the American Medical Association, vol 290, iss 2","raw_type":"article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9476000070571899,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[{"id":"https://openalex.org/G1900575853","display_name":null,"funder_award_id":"AG-02-004","funder_id":"https://openalex.org/F4320337337","funder_display_name":"National Institute on Aging"}],"funders":[{"id":"https://openalex.org/F4320337337","display_name":"National Institute on Aging","ror":"https://ror.org/049v75w11"}],"has_content":{"pdf":true,"grobid_xml":false},"content_urls":{"pdf":"https://content.openalex.org/works/W2040402812.pdf"},"referenced_works_count":15,"referenced_works":["https://openalex.org/W1893944147","https://openalex.org/W1964040308","https://openalex.org/W1977139870","https://openalex.org/W1982358339","https://openalex.org/W2005308828","https://openalex.org/W2019502737","https://openalex.org/W2021616960","https://openalex.org/W2032783403","https://openalex.org/W2045394072","https://openalex.org/W2058692645","https://openalex.org/W2079105681","https://openalex.org/W2118608668","https://openalex.org/W2157452732","https://openalex.org/W2157613482","https://openalex.org/W2162989714"],"related_works":["https://openalex.org/W2089251804","https://openalex.org/W2039998796","https://openalex.org/W1982358339","https://openalex.org/W4408950777","https://openalex.org/W7165107882","https://openalex.org/W2111691871","https://openalex.org/W6990097502","https://openalex.org/W1979792032","https://openalex.org/W7213556650","https://openalex.org/W2004466978"],"abstract_inverted_index":{"CONTEXT:":[0],"Annual":[1],"dollar":[2],"limits,":[3],"or":[4,277],"\"caps,\"":[5],"on":[6],"drug":[7,29,48,154,240,300],"benefits":[8],"are":[9],"common":[10],"in":[11,78,108,207,282,318],"Medicare":[12,28,74,184,295],"managed":[13],"care":[14],"(Medicare":[15],"+":[16,75],"Choice)":[17],"and":[18,45,50,136,168,181,193],"have":[19],"been":[20],"part":[21],"of":[22,40,66,84,97,118,178,183,188,235,252,294,336],"several":[23],"proposals":[24],"for":[25,172,262,269,321,334],"a":[26,72,79,201,233,278,291],"national":[27],"benefit.":[30,301],"OBJECTIVES:":[31],"To":[32,302],"determine":[33],"how":[34],"cap":[35,44,234,267],"levels":[36],"affect":[37],"the":[38,43,53,94,150,170,219,253,257,266,283,304],"percentage":[39],"patients":[41,119,164,185,199,230,263,296,313],"exceeding":[42,120,130,141,149,212,225,310],"their":[46,298],"out-of-pocket":[47,126,137,209,239,319],"costs":[49,128,139,147,210,241,320],"to":[51,58,87,93,204,217,246,325],"identify":[52],"medications":[54,255,322],"that":[55,173],"contribute":[56],"most":[57],"prescription":[59,98,107,124,146,221,260],"costs.":[60,99],"DESIGN":[61],"AND":[62],"SETTING:":[63],"Cross-sectional":[64],"analysis":[65],"2001":[67,109],"pharmacy":[68],"claims":[69],"data":[70],"from":[71,123,133,144,243],"large":[73],"Choice":[76],"plan":[77,171],"mature":[80],"market":[81],"with":[82,256],"caps":[83,167,187,213,226],"750":[85,189,236],"dollars":[86,89,245,248],"2000":[88,194],"per":[90],"year":[91],"applied":[92],"plan's":[95],"share":[96],"PARTICIPANTS:":[100],"Patients":[101],"who":[102,165,231,264],"filled":[103],"at":[104],"least":[105],"1":[106],"(n":[110],"=":[111],"438":[112],"802).":[113],"MAIN":[114],"OUTCOME":[115],"MEASURES:":[116],"Percentages":[117],"caps,":[121,131,142,198,290,311],"identified":[122],"claims;":[125],"patient":[127,138],"before":[129,148,224,309],"calculated":[132],"patients'":[134],"co-payments;":[135],"after":[140,211],"estimated":[143],"total":[145,158,177,259],"cap.":[151],"Each":[152],"unique":[153],"was":[155],"ranked":[156],"by":[157,163,169],"expenditures,":[159],"which":[160],"included":[161],"spending":[162],"exceeded":[166,186,232,265,297],"drug.":[174],"RESULTS:":[175],"A":[176],"22%,":[179],"14%,":[180],"4%":[182],"dollars,":[190,192,195,237],"1000":[191],"respectively.":[196],"Across":[197],"faced":[200,314],"potential":[202],"2-":[203],"3-fold":[205],"increase":[206],"median":[208],"(179":[214],"dollars-305/mo":[215],"dollars)":[216],"continue":[218,303],"same":[220,284,305],"use":[222,307],"as":[223,308],"(79-100/mo":[227],"dollars).":[228],"For":[229],"yearly":[238],"ranged":[242],"564":[244],"4201":[247],"(5th-95th":[249],"percentiles).":[250],"Fifteen":[251],"20":[254],"highest":[258],"expenditures":[261],"were":[268,331],"chronic":[270,327],"conditions.":[271,328],"Seven":[272],"had":[273],"lower-cost":[274],"generic":[275,279],"versions":[276],"medication":[280,306],"available":[281,333],"treatment":[285],"class.":[286],"CONCLUSIONS:":[287],"At":[288],"lower":[289],"substantial":[292],"proportion":[293],"annual":[299],"these":[312,337],"potentially":[315],"high":[316],"increases":[317],"used":[323],"primarily":[324],"treat":[326],"Generic":[329],"options":[330],"not":[332],"many":[335],"drugs.":[338]},"counts_by_year":[{"year":2024,"cited_by_count":1},{"year":2019,"cited_by_count":1},{"year":2018,"cited_by_count":1},{"year":2014,"cited_by_count":1},{"year":2013,"cited_by_count":2},{"year":2012,"cited_by_count":2}],"updated_date":"2026-11-06T12:05:46.655746","created_date":"2016-06-24T00:00:00"}