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To the Editor: Rector¹ recently reported that enrollees in Medicare health maintenance organizations who had exhausted their capped prescription benefits were more likely than those who had not exhausted their capped benefit to disenroll from their health plan. We reexamined this relationship during a 2-year period for 3 plans varying in cap amount and administration of benefits.

Methods

Prescription and eligibility data were obtained from January 1, 1997, through December 31, 1998, for 3 Medicare health maintenance organization plans with capped prescription benefits. All plans were located in markets with moderate to high Medicare managed care penetration. Plan markets were located in West South Central (2 plans) and South Atlantic states (1 plan).

In 1997, annual capped benefits were $600 (plan A), $1000 (plan B), and $1500 (plan C) and were administered on a quarterly basis (ie, only one fourth of the annual cap amount was available each quarter). In 1998, . . . [Full Text of this Article]

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