Journal articles on the topic 'High cost medications'
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Gipson, Gregory, Janet L. Kelly, Christy M. McKinney, and Andrew A. White. "Optimizing Prescribing Practices of High-Cost Medications With Computerized Alerts in the Inpatient Setting." American Journal of Medical Quality 32, no. 3 (May 16, 2016): 278–84. http://dx.doi.org/10.1177/1062860616649660.
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Current literature does not consistently show a benefit to providing medication cost information to inpatient health care prescribers. This study assessed the effectiveness of computerized provider order entry alerts that displayed the cost of a high-cost medication alongside a lower cost alternative, targeting 3 high-cost medications. Medication utilization during the one year prior to the intervention was compared to usage in the year after implementation. Reduced utilization of high-cost medications was found when comparing pre to post. Ipratropium hydrofluoroalkane and fluticasone hydrofluoroalkane metered dose inhaler utilization were reduced by 29% and 62%, respectively ( P < .001 for both). A 71% decrease in intravenous chlorothiazide was observed ( P < .001); however, its effect was unable to be separated from implementation of a heart failure diuretic protocol during the study period. Overall, these results suggest computerized medication cost alerts that recommend a lower cost therapeutic alternative are effective in changing prescribing practices.
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Hlatky, Mark A. "Willingness to Pay for High-Cost Medications." Circulation 141, no. 15 (April 14, 2020): 1225–26. http://dx.doi.org/10.1161/circulationaha.120.045966.
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Monsen, Craig B., Joshua M. Liao, Barak Gaster, Kevin J. Flynn, and Thomas H. Payne. "The effect of medication cost transparency alerts on prescriber behavior." Journal of the American Medical Informatics Association 26, no. 10 (April 11, 2019): 920–27. http://dx.doi.org/10.1093/jamia/ocz025.
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Abstract Objective The purpose of this study was to determine if medication cost transparency alerts provided at time of prescribing led ambulatory prescribers to reduce their use of low-value medications. Materials and Methods Provider-level alerts were deployed to ambulatory practices of a single health system from February 2018 through April 2018. Practice sites included 58 primary care and 152 specialty care clinics totaling 1896 attending physicians, residents, and advanced practice nurses throughout western Washington. Prescribers in the randomly assigned intervention arm received a computerized alert whenever they ordered a medication among 4 high-cost medication classes. For each class, a lower cost, equally effective, and safe alternative was available. The primary outcome was the change in prescribing volume for each of the 4 selected medication classes during the 12-week intervention period relative to a prior 24-week baseline. Results A total of 15 456 prescriptions for high-cost medications were written during the baseline period including 7223 in the intervention arm and 8233 in the control arm. During the intervention period, a decrease in daily prescribing volume was noted for all high-cost medications including 33% for clobetasol propionate (p < .0001), 59% for doxycycline hyclate (p < .0001), 43% for fluoxetine tablets (p < .0001), and a non-significant 3% decrease for high-cost triptans (p = .65). Prescribing volume for the high-cost medications overall decreased by 32% (p < .0001). Conclusion Medication cost transparency alerts in an ambulatory setting lead to more cost-conscious prescribing. Future work is needed to predict which alerts will be most effective.
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Stern, Craig. "Specialty Pharmaceuticals – Utilization Management." Journal of Contemporary Pharmacy Practice 64, no. 3 (September 1, 2017): 15–23. http://dx.doi.org/10.37901/jcphp16-00011.
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Specialty medications are complicated, treat complicated diseases, and are costly. Yet, even if their cost was to be decreased by 50%, many of the specialty medications would still be too costly either with high copays, or be unaffordable under any circumstance. Hence the use and oversight of Specialty medications is more complex than just cost: effectiveness, risk and cost must be evaluated concurrently. Utilization is actually the great multiplier. No matter the individual cost of a medication, uncontrolled expansion of medication use leads to more drugs, and therefore, higher drug spend. Utilization management of Specialty medications is, thus, a multifactorial process that is as important as cost management. Human Insulin was the first of the so-called “Specialty Medication.” Specialty treatments followed for orphan and previously untreated diseases. Treatments for chronic diseases followed where Specialty medications replaced older small molecules. The major complication was that the cost of these new treatments rivals, and often exceeds, acute care hospital stays. Unfortunately, evidence has not always matched the comparative benefits of Specialty medications over their small molecule counterparts. As a result, the explosion of new Specialty medications has also stimulated the need for strong evidence that these medications are significant improvements over prior therapies. If so, how can they be affordable? Utilization management of Specialty medications shares many of the same elements that have been used for decades to monitor and manage all treatments; namely, prior authorization, drug utilization review, step therapy, and quantity limits. This paper will examine the approach to utilization management of Specialty medications with the goals of providing a template for providers to participate in this management as well as to understand the metrics applied when these medications are submitted for payment.
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Cinar, Pelin, Tracy Lin, and Kevin Rodondi. "Best practice alert and cost transparency information for high cost oncology medications." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 323. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.323.
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323 Background: Oncology medication cost is often absent from therapy decision process until issues arise with payer denial resulting in potential patient financial toxicity. To incorporate cost, Best Practice Alert (BPA) and Cost Transparency Information (CTI) for high cost oncology medication (HCOM) were implemented into prescribing platform as care coordination tools. Methods: Ten HCOM were identified in gastrointestinal (GI) and breast oncology groups for which BPA and CTI were developed. Over a 6 month period, HCOM prescriptions triggered BPAs to alert providers and to place automated referrals to social work (SW). CTI – with drug costs and comparable treatment plan(s) – were posted in prescribing platform. Descriptive analyses examined differences in total payment to hospital and patients out-of-pocket payments (OPP) between treatment plans. Pre- and post-intervention surveys evaluated oncologists’ perception and behavior toward treatment cost. Results: The analysis included 162 patients and 1406 medication claims. In the GI group, BPAs effectively identified treatments incurring higher mean total payment (diff = 46733, p < 0.001) and higher mean OPP (diff = 115, p < 0.001). For the breast group, the impact was mixed. BPAs identified treatments with higher total payment at the 90% quantile (p < 0.001) and higher mean total payment (diff = 72612, p < 0.001), but there was no statistically significant difference in OPP between treatments. Pre-intervention survey (n = 26, 50% response rate) indicated 46% of oncologists rarely discuss medication cost with patients and 35% rarely refer patients to SW. Only 4% of oncologists strongly agreed that they could easily acquire cost information. Post-intervention survey highlighted that CTI improved oncologists’ awareness of medication costs, but BPA exerted no substantial influence on provider behaviors. Conclusions: BPA intervention effectively highlighted treatment cost and accurately identified patients at risk for financial toxicity. The lack of statistically significant difference in oncologists’ behavior and perception may be due to a small sample size. Comments from providers suggest that BPA combined with OPP would be more useful in reducing financial toxicity.
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Hammond, Drayton A., Tiffany Chiu, Jacob T. Painter, and Nikhil Meena. "Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients." Hospital Pharmacy 53, no. 3 (November 6, 2017): 188–93. http://dx.doi.org/10.1177/0018578717739005.
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Purpose: Medication cost is frequently overlooked when treating critically ill patients. Stewardship of health care resources in high-utilization settings is imperative. This study was conducted to determine nonpharmacist health care providers’ knowledge and perceptions of medication costs in a medical intensive care unit (MICU). Methods: Nonpharmacist health care providers in a MICU completed a 27-item survey. The survey queried perceptions regarding medication cost, cost-limiting strategies, and most/least expensive medications in 8 classes, medication price ranges, and intravenous-to-oral comparisons for commonly prescribed medications. Responses were analyzed using descriptive statistics and compared between providers using Fisher exact tests. Results: Among 98 health care providers (76 medical trainees, 5 attending physicians, 17 nurses), when ordering a medication, 49% consider its cost. Few (15%) providers considered themselves knowledgeable regarding medication costs with no difference between providers ( P = .174). Attending physicians were more aware of the most/least expensive medications than residents (correct out of 16: 9.6 vs 8.5, P = .044). The correct price ranges for select medications (11%-36%, P = .373) and intravenous-to-oral relative costs (3%-49%, P = .596) were similarly low. Most (59%) believed pharmacists limit expensive medication use, particularly senior physicians (58% resident vs 100% attending, P = .007). Conclusion: In spite of a goal of cost consideration, most nonpharmacist health care providers are unaware of medication costs and fail to include them in decision making. These knowledge gaps and perceptions should inform future efforts to improve knowledge and attitudes regarding medication costs.
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Fox, Erin R., and Linda S. Tyler. "Potential Association between Drug Shortages and High-Cost Medications." Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 37, no. 1 (November 28, 2016): 36–42. http://dx.doi.org/10.1002/phar.1861.
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Gleason, Patrick, Catherine I. Starner, Brent W. Gunderson, Jeremy A. Schafer, and H. Scott Sarran. "Association of Prescription Abandonment with Cost Share for High-Cost Specialty Pharmacy Medications." Journal of Managed Care Pharmacy 15, no. 8 (October 2009): 648–58. http://dx.doi.org/10.18553/jmcp.2009.15.8.648.
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Zhang, Yichen, Haishaerjiang Wushouer, Sheng Han, Mengyuan Fu, Xiaodong Guan, Luwen Shi, and Anita Wagner. "The impacts of government reimbursement negotiation on targeted anticancer medication price, volume and spending in China." BMJ Global Health 6, no. 7 (July 2021): e006196. http://dx.doi.org/10.1136/bmjgh-2021-006196.
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IntroductionNew targeted therapies have changed cancer treatment in the past decades. However, high prices of targeted anticancer medications have increased economic burden for both patients and health insurance systems. In July 2017, China implemented combined medication price negotiation and mandatory reimbursement policies for 15 targeted anticancer medications. This study assesses effects of the policy on hospital procurement prices, volumes and spending.MethodsUsing a quasi-experimental interrupted time series design, we analysed procurement data from the Chinese Medical Economic Information of 789 public hospitals in 30 provinces between January 2016 and September 2018. The intervention group consisted of 15 targeted anticancer medications with negotiated prices in 2017. The comparison group consisted of six targeted anticancer medications without negotiated prices by 2018. The effective date of the policy was September 2017.ResultsAfter the implementation of the 2017 medication price negotiation and reimbursement policy, cost per defined daily dose (DDD) of the 15 targeted anticancer medications dropped US$71.21 on average from an average US$169.24/DDD before (p=0.000). Compared with what would have happened without the intervention, cost/DDD of price-negotiated medications decreased by 48.9% (p=0.000), procurement volumes increased by 143.0% (p=0.000) and hospital medication spending decreased by 6.9% (p=0.146).ConclusionsThe 2017 medication price negotiation and reimbursement policy decreased targeted medication procurement costs per DDD, increased volumes procured and at least temporarily contained spending. These changes should result in better access to and affordability of targeted anticancer medications in China.
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Jackson, Kristy, and Milap C. Nahata. "Rising Cost of Anticancer Medications in the United States." Annals of Pharmacotherapy 51, no. 8 (March 24, 2017): 706–10. http://dx.doi.org/10.1177/1060028017702406.
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With more than 1.6 million new cases of cancer occurring each year, anticancer medications are in high demand. Escalating prescription drug prices have become a significant concern. Anticancer medications are among the most expensive prescription medications, many of them exceeding $100 000 a year. The survival benefits of certain newer anticancer medications may be a few months more than that from the existing treatment but at a much higher price tag. Drug cost may play a substantial role in making treatment choices. Multiple factors leading to high prices and some potential solutions to lower them have been highlighted.
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Socal, Mariana P., Thomas Cordeiro, Gerard F. Anderson, and Ge Bai. "Estimating Savings Opportunities From Therapeutic Substitutions of High-Cost Generic Medications." JAMA Network Open 5, no. 11 (November 2, 2022): e2239868. http://dx.doi.org/10.1001/jamanetworkopen.2022.39868.
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ImportanceUse of generics is generally understood as a cost-saving practice. However, pharmacy benefit managers have an incentive to place higher-priced generic drugs on insurers’ drug formularies to profit by creating a large difference between the price negotiated with pharmacies and the price paid by insurers (what is known as spread pricing).ObjectiveTo examine price differentials and savings potential between high-cost generics and corresponding therapeutic alternatives of same clinical value and lower cost.Design, Setting, and ParticipantsThis cross-sectional analysis examined the top 1000 generics in Colorado’s all-payer claims database (CO-APCD) in 2019. High-cost generics and lower-cost generic therapeutic alternatives of same clinical value constituted the study sample. Data were analyzed from January 2019 to December 2019.ExposuresGeneric drug prices measured by transaction prices, average wholesale price (AWP), and national drug acquisition average cost (NADAC).Main Outcomes and MeasuresPrice differentials between the high-cost generics and the corresponding therapeutic alternatives. Levels of discounts and savings that could be achieved if the high-cost generics had been substituted by their therapeutic alternatives.ResultsThis cross-sectional study of the top 1000 CO-APCD generics identified 45 high-cost products that had lower-cost therapeutic alternatives of same clinical value. Overall, high-cost generics were 15.6 times more expensive than their therapeutic alternatives (median values). If the lower-cost alternatives had been used, total spending would have been reduced from $7.5 million to $873 711, resulting in 88.3% savings. Most substitutions (28 of 45 [62.2]%) involved different dosage forms or different strengths of the same drug and provided mean (SD) discounts of 94.9% (3.8%) and 77.1% (19.9%), respectively.Conclusions and RelevanceIn this study, replacing high-cost generics with lower-cost alternatives of same clinical value would produce savings of nearly 90%. Plan sponsors should be aware that some generics are associated with higher spending and should periodically review the specific products driving their generic drug spending. Substitution of high-cost generics may provide a simple pathway to offer the same therapeutic benefit at lower cost to patients and insurers.
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Huq, Nishat, Eimeira Padilla-Tolentino, and Brandy McGinnis. "Identifying Potential High-Risk Medication Errors Using Telepharmacy and a Web-Based Survey Tool." INNOVATIONS in pharmacy 12, no. 1 (February 12, 2021): 9. http://dx.doi.org/10.24926/iip.v12i1.3377.
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Background and Introduction: Obtaining patient medication histories during emergency department (ED) admissions is an important step towards identifying potential errors that could otherwise remain in the patient’s active medication list. This is a descriptive report of a standardized, electronic data collection tool created to document potential medication errors in patients receiving high-risk medications during ED admissions. Materials and Methods: Trained pharmacy technicians completed a survey following medication history collection using a secure web platform called REDCap®. Data collected included patient-specific information, the number and type of high-risk medications, and potential medication errors identified in the collection process. Results: During a pilot period of April 2019 to October 2020, 191 patient records were completed using the survey tool. Out of a total of 1088 medications recorded, 41% were considered high-risk medications. 42% of potential medication errors were classified as high-risk medication errors. Results from this survey tool demonstrated that 58% of high-risk medication orders could potentially result in a medication error that can be carried through patient admission and discharge. Discussion: Accurate medication history and transitions of care can significantly impact patient quality of life. The cost of addressing a medication related-adverse event is also substantial. Based on published reports, annual gross savings to a hospital is estimated to be $4532 per harmful error in 2020, after adjusting for inflation. This equated to approximately $1,182,852 in estimated savings for Ascension Texas in 18 months. Nationwide, preventing potential medication errors in an outpatient setting can save on average $3.5 billion per year. Conclusion: This web-based survey tool has improved the quality and efficiency of potential error identification during medication history collection by pharmacy technicians. This information can be easily retrieved and aid in discussions regarding medication reconciliation at the leadership level and impact patient treatment outcomes by developing virtual processes that may result in fewer medication related events.
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Lokant, Matthew, Shu Xian Lee, Connor Nevin, John D. Lindsay, Colby Acri, Miles Graves, Katherine L. Bergman, John Guilfoose, and Catessa Howard. "47. Transitioning to Batch Dosing of High-Cost Antimicrobials in the Inpatient Setting." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S144. http://dx.doi.org/10.1093/ofid/ofab466.249.
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Abstract Background Antimicrobial stewardship (AMS) committees ensure appropriate antimicrobial utilization. One stewardship intervention is to evaluate the delivery model of high-cost antimicrobials to better utilize resources and mitigate expenses. We analyzed the total medication waste and costs of high-cost antimicrobials, specifically daptomycin, ertapenem, amphotericin, and micafungin, at our institution and propose innovative cost-savings changes at a systems level. Methods This retrospective study consisted of 263 patients. All patients were at least 18 years old who was admitted to our academic institution from January 2020 to April 2021 and received daptomycin, ertapenem, amphotericin, or micafungin. Demographics, daily medication dosage, total doses received, the date and time of the start of the medication, last administered dose, and discontinued order were recorded. Results The daptomycin cohort consisted of 143 patients with 46.2% females and average age of 56.3 years. In this group, 145.3 vials were wasted which equated to a loss of &22,630. The ertapenem group had 53 patients with 62.3% females and a mean age of 62.3 years. There were 24 vials wasted with a calculated loss of &1080. The amphotericin cohort had 32 patients with an average age of 52.2 years and 43.8% females. There were 189 vials wasted with a loss of &46,116. The micafungin group had 35 patients with 42.9% females and average age of 60.4 years. This group had 12 vials wasted with a loss of &2052. Conclusion Each antimicrobial has a specific formulation protocol. Daptomycin and ertapenem formulation occurs in the early morning. Amphotericin formulation occurs 2 hours prior to medication use. Micafungin formulation occurs at the time the order label prints. These medications were more often administered in the late morning to early afternoon timeframe. The order to discontinue the medications also occurred at the same interval. One reason could be due to decisions made on morning rounds from primary teams and specialty input. These orders would then be placed after rounds. A cost-saving method would be to batch and change the formulation time for all antimicrobials to later in the afternoon, which would not only prevent waste, but also allow the AMS team to effectively audit appropriate antimicrobial use. Disclosures All Authors: No reported disclosures
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Scott, Anthony T., Paula E. Pecen, and Alan G. Palestine. "Ophthalmic medication price variation across the United States: Anti-inflammatory medications." Therapeutic Advances in Ophthalmology 11 (January 2019): 251584141986363. http://dx.doi.org/10.1177/2515841419863638.
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Background: Cost-related nonadherence to medication can impact ophthalmic treatment outcomes. We aimed to determine whether medication prices vary between US cities and between different types of pharmacies within one city. Methods: We conducted a phone survey of eight nationwide and five independent pharmacies in five cities across the United States: Boston, Massachusetts; Charlotte, North Carolina; Denver, Colorado; Detroit, Michigan; and Seattle, Washington. A researcher called each pharmacy asking for price without insurance for four common anti-inflammatory ophthalmic medications: prednisolone acetate, prednisolone sodium phosphate, difluprednate (Durezol™), and loteprednol etabonate (Lotemax™). Results: Prednisolone sodium phosphate price could only be obtained by a small subset of pharmacies (45.2%) and was excluded from additional analysis; however, preliminary data demonstrated lower cost of prednisolone sodium phosphate over prednisolone acetate. Three-way analysis of variance revealed no interaction between pharmacy type (chain versus independent), city, and drug ( F = 0.40, p = 0.92). A significant interaction was identified between pharmacy type and drug ( F = 5.0, p = 0.008), but not city and pharmacy type ( F = 0.66, p = 0.62) or city and drug ( F = 0.27, p = 0.97). Average drug prices were lower at independent pharmacies compared with chain pharmacies for difluprednate (US$211.36 versus US$216.85, F = 1.09, p = 0.297) and significantly lower for loteprednol etabonate (US$255.49 versus US$274.86, F = 14.7, p < 0.001). Prednisolone acetate was cheaper at chain pharmacies, but not statistically significantly cheaper (US$48.82 versus US$51.61, F = 0.34, p = 0.559). Conclusions: Medication prices do not differ significantly between US cities. High variation of drug prices within the same city demonstrates how comparison shopping can provide cost savings for patients and may reduce cost-related nonadherence.
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Hennes, Emily R., Michael Reed, Mary Mably, Jason Jared, Jason J. Bergsbaken, Dustin Deming, Natalie Callander, and Ruth O’Regan. "Implementation of a chemotherapy stewardship process." American Journal of Health-System Pharmacy 77, no. 15 (July 4, 2020): 1243–48. http://dx.doi.org/10.1093/ajhp/zxaa157.
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Abstract Purpose To design and implement a chemotherapy stewardship process to optimize the location of chemotherapy administration in an effort to decrease the number of inappropriate inpatient anticancer regimen administrations and decrease institutional costs associated with inpatient administration. Summary As the costs of anticancer agents continue to rise, it is crucial that multidisciplinary efforts are aimed at managing anticancer medication utilization; this is especially important for high-cost medications, medications whose use requires increased monitoring due to safety concerns, and medications that do not exert effects quickly and, as such, can be more appropriately administered in the outpatient setting. It is imperative that pharmacists play a role in managing chemotherapy medication utilization, as pharmacists provide expertise in formulary management, a vast knowledge of financial impact and reimbursement processes, and clinical knowledge that can help predict the expected effectiveness and adverse effects of each anticancer regimen. Our institution sought to develop and implement a multidisciplinary chemotherapy stewardship program targeting the optimization of site of anticancer agent administration with a goal of decreasing both cost and inappropriate utilization of high-cost, high-risk anticancer agents. Conclusion Implementation of a chemotherapy stewardship service may decrease the number of inappropriate inpatient anticancer regimen administrations and decrease inpatient resource use, thereby decreasing costs to institutions. The concept of a chemotherapy stewardship process was well received by multidisciplinary healthcare colleagues, and a collaborative approach should be used to design and implement such processes.
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Garrido, Melissa M., and Austin B. Frakt. "Improving adherence to high-value medications through prescription cost-sharing policies." BMJ Quality & Safety 27, no. 11 (April 19, 2018): 868–70. http://dx.doi.org/10.1136/bmjqs-2018-007916.
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Ma, Yuk Ting, and Daniel H. Palmer. "Impact of restricting access to high-cost medications for hepatocellular carcinoma." Expert Review of Pharmacoeconomics & Outcomes Research 12, no. 4 (August 2012): 465–73. http://dx.doi.org/10.1586/erp.12.33.
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Hussey, Leslie C., Sonya Hardin, and Christopher Blanchette. "Outpatient Costs of Medications for Patients with Chronic Heart Failure." American Journal of Critical Care 11, no. 5 (September 1, 2002): 474–78. http://dx.doi.org/10.4037/ajcc2002.11.5.474.
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• Background The outpatient costs of medications prescribed for chronic heart failure are high and are often borne by individual patients. Lack of financial resources may force noncompliance with use of medications. • Objective To compare the outpatient costs of medications for patients with different New York Heart Association classifications of chronic heart failure. • Methods The charts of 138 patients with chronic heart failure were reviewed retrospectively. Outpatient costs of medications were obtained from the Web sites of commercial pharmacies. Medications were classified by type according to the system of the American Heart Association. A mean cost for each classification of medication was used for analysis. • Results The overall mean monthly cost of medications for chronic heart failure was $438. Patients with class II and class III chronic heart failure had the highest costs: $541 and $514, respectively. Analysis of variance indicated that the differences in monthly costs of medications between the patients with the 4 stages of chronic heart failure were significant (F = 4.86, P = .003). A post hoc Scheffé test revealed significant differences in costs between patients with class I and patients with class II heart failure (P=.02) and between patients with class I and those with class III heart failure (P=.02). • Conclusions The outpatient costs of medications for chronic heart failure are significant. Ability to pay for prescribed medications must be determined. Healthcare professionals must maintain an awareness of the costs of medications and patients’ ability to pay.
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HARROLD, LESLIE R., BECKY A. BRIESACHER, DAN PETERSON, ASHLEY BEARD, JEANNE MADDEN, FANG ZHANG, JERRY H. GURWITZ, and STEPHEN B. SOUMERAI. "Cost-related Medication Nonadherence in Older Patients with Rheumatoid Arthritis." Journal of Rheumatology 40, no. 2 (January 15, 2013): 137–43. http://dx.doi.org/10.3899/jrheum.120441.
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Objective.Economic access to costly medications including biologic agents can be challenging. Our objective was to examine whether patients with rheumatoid arthritis (RA) are at particular risk for cost-related medication nonadherence (CRN) and spending less on basic needs.Methods.We identified a nationally representative sample of older adults with RA (n = 1100) in the Medicare Current Beneficiary Survey (2004–2008) and compared them to older adults with other morbidities categorized by chronic disease count: 0 (n = 5898), 1–2 (n = 30,538), and ≥ 3 (n = 34,837). We compared annual rates of self-reported CRN (skipping or reducing medication doses or not obtaining prescriptions because of cost) as well as spending less on basic needs to afford medications and tested for differences using survey-weighted logistic regression analyses adjusted for demographic characteristics, health status, and prescription drug coverage.Results.In the RA sample, the unadjusted weighted prevalence of CRN ranged from 20.7% in 2004 to 18.4% in 2008 as compared to 18.5% and 11.9%, respectively, in patients with 3 or more non-RA conditions. In adjusted analyses, having RA was associated with a 3.5-fold increase in the risk of CRN (OR 3.52, 95% CI 2.63–4.71) and almost a 2.5-fold risk of spending less on basic needs (OR 2.41, 95% CI 1.78–3.25) as compared to those without a chronic condition.Conclusion.Patients with RA experience a high prevalence of CRN and forgoing of basic needs, more than do older adults with multiple other chronic conditions. The situation did not improve during a period of policy change aimed at alleviating high drug costs.
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Lee, SuHak, and Jon C. Schommer. "Medication Use and Storage, and Their Potential Risks in US Households." Pharmacy 10, no. 1 (February 9, 2022): 27. http://dx.doi.org/10.3390/pharmacy10010027.
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Background: Medications stored in US households may pose risks to vulnerable populations and the environment, potentially increasing societal costs. Research regarding these aspects is scant, and interventions like medication reuse may alleviate negative consequences. The purpose of this study was to describe medications stored in US households, gauge their potential risk to minors (under 18 years of age), pets, and the environment, and estimate potential costs of unused medications. Methods: A survey of 220 US Qualtrics panel members was completed regarding medications stored at home. Published literature guided data coding for risks to minors, pets, and the environment and for estimating potential costs of unused medications. Results: Of the 192 households who provided usable and complete data, 154 (80%) reported storing a medication at home. Most medications were taken daily for chronic diseases. The majority of households with residents or guests who are minors and those with pets reported storing medications with a high risk of poisoning in easily accessible areas such as counters. Regarding risk to the aquatic environment, 46% of the medications had published data regarding this risk. For those with published data, 42% presented a level of significant risk to the aquatic environment. Unused medications stored at home had an estimated potential cost of $98 million at a national level. Implications/Conclusions: Medications stored at home may pose risks to vulnerable populations and the environment. More research regarding medications stored in households and their risks is required to develop innovative interventions such as medication reuse to prevent any potential harm.
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R. Bhatt, Tarang, and Dharmesh K. Golwala. "Review on Cost of Anti-Glaucoma Formulation Available in India." Biomedical and Pharmacology Journal 15, no. 3 (September 29, 2022): 1213–25. http://dx.doi.org/10.13005/bpj/2457.
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The objective of the present work was to determine cost per annum of various glaucoma formulation to patients and plot changes in trends of cost these formulations over years. Main purpose of this study is to provide patients and health care providers with calculated yearly costs of topical glaucoma medications in India. A price per ml model was used to eradicate difference due to pack size of formulation of different brands. And average prices per ml of all studied brands were used to present data of particular drug formulation. Daily recommended drops were also taken into consideration to obtain cost of formulation to patient per year. And results indicated that cost of glaucoma treatment in India per annum to patient varied from as low as 193.3 INR to as high as 6616.72 INR in year 2015, quite similar to that in 2005 wherein cost per annum to patient varied from 191.55 INR to 5879.12 INR. Beta blockers were reported to be the most economical group of glaucoma medications while prostaglandin analogues and its combinations were reported to be expensive group of glaucoma medications. And the study concluded that cost of glaucoma drug therapy varies from few hundred to several thousand rupees in India. And although price per annum of glaucoma medication in India remains to be significantly less compared to other developed countries, steep rising cost first line drugs like timolol maleate over the years forecasts risings concern to patient in India.
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Slater, Bethany J., Nina Bellatorre, and Dan Eisenberg. "Early Postoperative Outcomes and Medication Cost Savings after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Type 2 Diabetes." Journal of Obesity 2011 (2011): 1–5. http://dx.doi.org/10.1155/2011/350523.
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Background. We investigated the effect of laparoscopic sleeve gastrectomy (LSG) on morbidly obese diabetics and examined the short-term impact of LSG on diabetic medication cost.Methods. A prospective database of consecutive bariatric patients was reviewed. Morbidly obese patients with type 2 diabetes who underwent LSG were included in the study. Age, gender, body mass index (BMI), diabetic medication use, glucose, insulin, and HbA1c levels were documented preoperatively, and at 2 weeks, 2 months, 6 months, and 12 months postoperatively. Insulin resistance was estimated using the homeostatic model assessment (HOMA). Use and cost of diabetic medications were followed.Results. Of 178 patients, 22 were diabetics who underwent LSG. Diabetes remission was observed in 62% of patients within 2 months and in 75% of patients within 12 months. HOMA-IR improved after only two weeks following surgery (16.5 versus 6.6, ). Average number of diabetic medications decreased from 2.2 to <1, within 2 weeks after surgery; corresponding to a diabetes medication cost savings of 80%, 91%, 99%, and 99.7% after 2 weeks, 2 months, 6 months, and 12 months, respectively.Conclusion. Morbidly obese patients with diabetes who undergo LSG have high rates of diabetes remission early after surgery. This translates to a significant medication cost savings.
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Chiu, Shin-Lin, Chiao-Lee Chu, Chih-Hsin Muo, Chiu-Liang Chen, and Shou-Jen Lan. "Trends in Glaucoma Medication Expenditures under Universal Health Coverage: A National Population-Based Longitudinal Survey in Taiwan." Journal of Ophthalmology 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/243401.
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Medical care in Taiwan is well known for its low cost, high efficiency, high quality, excellent medical accessibility, and high equity. We investigate the trends in medication expenditures for glaucoma from 1997 to 2010. The results show that higher medical expenditures were incurred by patients who were aged ≥40 years, male patients, and patients in the highest salary population whereas lower medical expenditures were incurred by blue-collar workers. The medications with the most significant increases in expenditure were prostaglandin analogs (PGAs),α-agonists, and fixed combinations, whereas the medications with the most significant decreases in expenditure wereβ-blockers and cholinergic agonists. The number of trabeculectomies shows two downward break points in 1999 and 2000 when PGAs were listed and were reimbursed. These results suggest socioeconomic disparities in glaucoma care, as well as understanding of the changes in the expenditure of glaucoma medications under such universal health insurance coverage system.
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Canon, O., L. Daza, J. Gomez, I. Moreno, C. Castillo, and J. Rodriguez. "PMS8 HIGH-COST MEDICATIONS IN 10 COUNTRIES: A CROSS-SECTIONAL COMPARATIVE STUDY." Value in Health 13, no. 3 (May 2010): A123. http://dx.doi.org/10.1016/s1098-3015(10)72596-1.
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Callaghan, Brian C., Evan Reynolds, Mousumi Banerjee, Kevin A. Kerber, Lesli E. Skolarus, Brandon Magliocco, Gregory J. Esper, and James F. Burke. "Out-of-pocket costs are on the rise for commonly prescribed neurologic medications." Neurology 92, no. 22 (May 1, 2019): e2604-e2613. http://dx.doi.org/10.1212/wnl.0000000000007564.
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ObjectiveTo determine out-of-pocket costs for neurologic medications in 5 common neurologic diseases.MethodsUtilizing a large, privately insured, health care claims database from 2004 to 2016, we captured out-of-pocket medication costs for patients seen by outpatient neurologists with multiple sclerosis (MS), peripheral neuropathy, epilepsy, dementia, and Parkinson disease (PD). We compared out-of-pocket costs for those in high-deductible health plans compared to traditional plans and explored cumulative out-of-pocket costs over the first 2 years after diagnosis across conditions with high- (MS) and low/medium-cost (epilepsy) medications.ResultsThe population consisted of 105,355 patients with MS, 314,530 with peripheral neuropathy, 281,073 with epilepsy, 120,720 with dementia, and 90,801 with PD. MS medications had the fastest rise in monthly out-of-pocket expenses (mean [SD] $15 [$23] in 2004, $309 [$593] in 2016) with minimal differences between medications. Out-of-pocket costs for brand name medications in the other conditions also rose considerably. Patients in high-deductible health plans incurred approximately twice the monthly out-of-pocket expense as compared to those not in these plans ($661 [$964] vs $246 [$472] in MS, $40 [$94] vs $18 [$46] in epilepsy in 2016). Cumulative 2-year out-of-pocket costs rose almost linearly over time in MS ($2,238 [$3,342]) and epilepsy ($230 [$443]).ConclusionsOut-of-pocket costs for neurologic medications have increased considerably over the last 12 years, particularly for those in high-deductible health plans. Out-of-pocket costs vary widely both across and within conditions. To minimize patient financial burden, neurologists require access to precise cost information when making treatment decisions.
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Khera, Rohan, Javier Valero-Elizondo, Sandeep R. Das, Salim S. Virani, Bita A. Kash, James A. de Lemos, Harlan M. Krumholz, and Khurram Nasir. "Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017." Circulation 140, no. 25 (December 17, 2019): 2067–75. http://dx.doi.org/10.1161/circulationaha.119.041974.
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Background: Medication nonadherence is associated with worse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD), a group who requires long-term therapy for secondary prevention. It is important to understand to what extent drug costs, which are potentially actionable factors, contribute to medication nonadherence. Methods: In a nationally representative survey of US adults in the National Health Interview Survey (2013–2017), we identified individuals ≥18 years with a reported history of ASCVD. Participants were considered to have experienced cost-related nonadherence (CRN) if in the preceding 12 months they reported skipping doses to save money, taking less medication to save money, or delaying filling a prescription to save money. We used survey analysis to obtain national estimates. Results: Of the 14 279 surveyed individuals with ASCVD, a weighted 12.6% (or 2.2 million [95% CI, 2.1–2.4]) experienced CRN, including 8.6% or 1.5 million missing doses, 8.8% or 1.6 million taking lower than prescribed doses, and 10.5% or 1.9 million intentionally delaying a medication fill to save costs. Age <65 years, female sex, low family income, lack of health insurance, and high comorbidity burden were independently associated with CRN, with >1 in 5 reporting CRN in these subgroups. Survey respondents with CRN compared with those without CRN had 10.8-fold higher odds of requesting low-cost medications and 8.9-fold higher odds of using alternative, nonprescription, therapies. Conclusions: One in 8 patients with ASCVD reports nonadherence to medications because of cost. The removal of financial barriers to accessing medications, particularly among vulnerable patient groups, may help improve adherence to essential therapy to reduce ASCVD morbidity and mortality.
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Jeon, Chaeok, and Maya Leiva. "Impact of an internal specialty pharmacy medication assistance program on the adherence rates of oral oncolytics." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e18576-e18576. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e18576.
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e18576 Background: High-cost medications pose a barrier to adherence which results in poor therapeutic outcomes and an increase in overall healthcare spending. Medication adherence is critical, especially in cancer patients, in order to achieve optimal, progression-free and disease-free survival. The projected cost of cancer continues to rise, putting patients at a greater risk for delayed treatment and nonadherence. This study evaluates the impact financial assistance has on medication adherence by comparing the oncolytic adherence rates found in published literature with the rates found in patients receiving financial assistance through an internal specialty pharmacy. Methods: This was a single-center, retrospective chart review evaluating patients over 18 years of age who received Hisaoka Cancer Fund and filled their oral oncolytic medications with the internal health system specialty pharmacy. The outpatient pharmacy software and electronic health records were utilized to run reports based on the eligibility criteria between January 1, 2020 and June 30, 2020. Patient demographics included age, gender, race, and cancer diagnosis. Patients younger than 18 years of age, who filled injectable oncolytics or supportive medications, have incomplete data, or were on off-label prescription drugs were excluded. The medication possession ratio (MPR) and time-to-treatment (TTT) in patients receiving the fund were compared to adherence rates found in the literature. Results: A total of 167 patients with a total of 297 prescription fills were evaluated. The MPRs had an average of 82.8% with a median of 92.8% (range 53.8% – 100%). The average TTT was 1.1 days, with a median of 0 day (range 0 – 12 days). In contrast, MPRs found in the two published studies were 75% and 61%, respectively and TTTs were found to be 10.9 and 27 days in those who filled medications through an external specialty pharmacy. A total of $12,793.43 was covered by the fund, with an average of $1,599.18 per patient during the six-month period. Conclusions: Adherence rates in patients who received the medication assistance program through internal health system specialty pharmacy exceeded the rates found in patients who filled medications from external pharmacies. The Hisaoka Fund reduced the financial burden by covering the cost of medications. Due to limited number of patients, further studies are needed to evaluate the impact of the medication assistance program on adherence rates across institutions.[Table: see text]
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Cram, David Lee, Ann T. Maesner, and Douglas M. Witmore. "Medication Refill Clinics: The Veterans Administration Medical Center Experience." Journal of Pharmacy Practice 5, no. 1 (February 1992): 12–21. http://dx.doi.org/10.1177/089719009200500105.
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Medication refill clinics have been operating for about two decades. These clinics provide cost-effective and high-quality pharmaceutical care to patients who require refills on their medications. The following article describes one Veterans Affairs Medical Center's experience with a medication refill clinic. Guidelines for setting up a refill clinic are presented, including clinic development and justification, training of the practitioner, policies and procedures, and quality assurance management. Benefits of the clinic also will be discussed.
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Ives, Hope, Erica Feinberg, Puneeth Indurlal, Lalan S. Wilfong, Kaci Dominguez, and Jody S. Garey. "Therapeutic interchange: The cornerstone of cost effectiveness in the Oncology Care Model performance for the U.S. Oncology Network." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 5. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.005.
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5 Background: The Oncology Care Model (OCM) is a Medicare value-based care program, that rewards practices for decreasing the total cost of care (TCOC) compared to a benchmark price. Enrolled patients are evaluated in 6-month episodes within a 1-year time window called Performance Periods (PP). The use of lower cost medication alternatives (LCA) is a critical strategy to bend the cost curve. Therapeutic interchange (TIC) with lower-cost generic/biosimilar/therapeutic alternative medications offer significant cost savings to payers and patients while maintaining equivalent quality of care. LCA for eight high-cost oncology therapeutic or supportive care medications became available during or just prior to OCM. The results of a clinically appropriate, physician-supported, pharmacist-led interchange of high-cost medications to LCA in The US Oncology Network (The Network) during OCM PP 7 (PP7), 8 (PP8), and 9 (PP9) is described here. Methods: Medicare Part B & D claims for 14 OCM practices in The Network were used to evaluate the impact of eight TIC opportunities during PP 7-9. TIC opportunities included changing therapy from reference products to biosimilars (bevacizumab, trastuzumab, rituximab, pegfilgrastim and filgrastim), from brand to generics (abiraterone, imatinib, fosaprepitant) and from high cost to LCA (aprepitant to fosaprepitant, denosumab to zoledronic acid). TCOC impact was measured by comparing the cost of each dose of the LCA vs the estimated cost if the more expensive alternative had been used instead. Results: The shift from high cost to LCAs in PP7, PP8 and PP9 is shown in Table as percentage of total doses dispensed or administered. Transitions from aprepitant to fosaprepitant, and from denosumab to zoledronic acid was done when clinically appropriate (as determined by the treating physician). The cumulative savings from TIC was $26.0M in PP7, $32.3M in PP8 and $32.9M in PP9. TIC to biosimilars contributed $6.6M in PP8 and $12.2M in PP9 of the cumulative savings. TIC reduced TCOC by 2.78% in PP7, 4.13% in PP8, 5.25% in PP9 within the OCM. Conclusions: TIC to biosimilars, generics and clinically appropriate LCA is an effective way to reduce TCOC while maintaining quality care in the OCM. Even small shifts in utilization towards LCA can generate a significant reduction in TCOC. Physician-supported, pharmacist-led TIC initiatives are critical to bending the cost curve within Oncology.[Table: see text]
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Addo, Bright, Sally Sencherey, and Michael N. K. Babayara. "Medication Noncompliance among Patients with Chronic Diseases Attending a Primary Health Facility in a Periurban District in Ghana." International Journal of Chronic Diseases 2018 (June 7, 2018): 1–10. http://dx.doi.org/10.1155/2018/7187284.
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Background. Despite the growing interest in understanding the aetiology of chronic diseases, limited studies exist on medication noncompliance, especially, among periurban and rural dwellers in Ghana. In this study, we determined the prevalence of medication noncompliance and explored the medication intake behaviour of patients with chronic diseases. The relative influence of cost on medication noncompliance and the risk factors for noncompliance were also assessed. Methods. The design was a cross-sectional study of 200 patients from ages below 40 years to ages above 60 years sampled from the Offinso South Municipality, a periurban district of the Ashanti region of Ghana. Data collected through the administration of structured questionnaires was coded, cleaned, and analysed using the SPSS (v20) software programme. Descriptive and multivariate analyses using binary logistic regression were performed. Results. Medication noncompliance was high (55.5%), with patients living with HIV/AIDS and those with psychological disorders being the most noncompliant. Majority of patients took at least 2 medications (81.5%), did so twice daily (79.0%), did not experience side effects with intake (67.0%), considered their medication to be effective (88.5%), and were aware of the complications that could arise from noncompliance. The dominant route of medication intake was oral (86.8%) and a lesser proportion of patients (22.5%) took herbal preparation alongside their prescribed medications. The cost of medication did not prevent patients from adhering to their medication regimen as most of these drugs were covered by the National Health Insurance Scheme (NHIS). Age, duration of diagnosis and difficulty in remembering medication instructions were identified as significant predictors of noncompliance. Conclusion. Educating patients on the need to be compliant with their medication regimen, the complications that could arise from noncompliance and avoidance of intake of herbal medications during their treatment should form part of the clinical sessions organized for patients with chronic conditions.
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Ibrahem, Dr Hajer Ibrahem, Dr Mohammed Suhail Najm, Dr Nathaniel S. Treister, and Dr Daniel H. Solomon. "Resource Utilization in Patients with Bisphosphonate - Associated Osteonecrosis of the Jaw." Mustansiria Dental Journal 9, no. 2 (March 4, 2018): 218–28. http://dx.doi.org/10.32828/mdj.v9i2.266.
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Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is an emerging oralcomplication that occur secondary to cancer therapy in approximately 5% of cancerpatients that are treated with high dosages of intravenous (IV) bisphosphonates andcan be associated with significant health-care associated costs.A retrospective electronic medical record based on review of ninety-four cancerpatients with BONJ. All health care related resources were abstracted using astructured chart abstraction tool, including medications, imaging, pathology,procedures, and visits. Standardized references were used to assign costs.The median cost of a case of BONJ in our cohort was $1,546 (interquartile rangefrom $869-$3,166). Medication costs comprise 48%, visits 23%, procedures 16%,imaging 10% and pathology 2%. The major contributing factors that affect BONJtreatment cost were long term medication and follow up visitsLong term medication, sequestrectomy and debridement are a bit expensive butcould be a part of evidence-based successful clinical outcome. The cost of BONJtreatment is modest compared with the cost of cancer care.
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Eng, Stephen William, Grashma Vadakkel, Warren B. Fingrut, Susan Murillo, Samantha Brown, Sean M. Devlin, Melinda Cook, et al. "Insurance Barriers to High-Cost Anti-Infective Medications Post Allogeneic Hematopoietic Cell Transplant." Transplantation and Cellular Therapy 29, no. 2 (February 2023): S349—S350. http://dx.doi.org/10.1016/s2666-6367(23)00530-4.
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Gao, Limin, Jivin Joseph, Marcelle Levy-Santoro, Vladimir Gotlieb, and Alan S. Multz. "Utilization of prescription-assistance program for medically uninsured cancer patients: A case study of a public hospital experience in New York state." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e17537-e17537. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e17537.
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e17537 Background: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading therapeutic classes in hospital drug expenditures. Lack of insurance is associated with lower rates of cancer screening, later stage at diagnosis, and increased cancer mortality. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at NUMC with drug costs for chemotherapies and maintain the quality care for patients, the Pharmacy department instituted a Patient Assistance Program (PAP) to obtain medication from the drug companies at no cost. NUMC is a “safety net” teaching hospital in suburban New York. It serves mostly an indigent population and is a Level 1 Trauma Center with over 77,000 emergency department visits per year. Methods: We followed all patients requiring assistance with chemotherapy who enrolled in our PAPs from January 1, 2011 to December 31, 2012. Individuals potentially eligible for PAPs were identified by Oncologists and by the pharmacy department. Medications included both oral and parenteral chemotherapy drugs and antiemetics. Results: The program served 341 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. Conclusions: PAPs provide a valuable safety net to ensure that cancer patients without insurance receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. A pharmacy-based program to procure free medications for uninsured cancer outpatients has helped to defray the Cancer Care Center’s expense of providing care at NUMC, increased patients’ compliance with chemo-protocols and allowed many patients to receive the treatment they otherwise would not be able to afford.
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Varghese, Susy, Jaya Sheela Amaram-Davila, and Marina C. George. "Prior authorization process improvement for pain medications in an oncology unit: Timely initiation of test claim request form." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 7050. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.7050.
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7050 Background: Oncology patients with extensive metastatic disease and advanced-stage cancer frequently require controlled medications for pain managements. Insurers require Prior Authorization (PA) for high-cost specialty medications including: Hydromorphone, Oxycodone, Oxymorphone, Fentanyl, Nucynta, Lyrica and Lidocaine patch. Failure to obtain PA may delay patient hospital discharge and attainment of discharge medications, increase patient medication costs, increase hospital readmissions and emergency visits, and exacerbate clinical complications. In order to avoid delays, providers must submit a Claim Request (CR) to initiate the PA process. PA usually takes 48-72 hours after the CR is submitted; therefore, timely CR submission in anticipation of discharge is imperative. Baseline rates for initiating CR in a timely manner was 15%. A quality improvement project was conducted to increase provider-initiated CRs for prescribed pain medications requiring PA and to demonstrate a sustainable process, anchored by development of new policy. Methods: The project revised the provider-initiated CR process by implementing the following interventions: The Electronic Medical Record (EHR) was modified to create a ‘quick link’ to facilitate CR form submissions. The link was made available to providers via their dashboard for easy access to the CR form.The medication reconciliation process was revised to require nurses to send reminders to providers for any of the seven discharge medications requiring CR submission for PA. A new component was incorporated into the discharge planning process by discussing PA and CR during interdisciplinary rounds. Providers and nurses were educated about the revised process. Results: Rates for timely CR submission were collected from the EHR biweekly for 3 months post-intervention. Post-intervention, 77% of timely CR claims increased from baseline of 15% to 87%. Due to the timely initiation of CR, some medications were deemed not to require PA, and the percentage of PA requirement reduced from 95% to 55%. In addition, up to 16% of patients had money refunded as a result of timely CR submission. Conclusions: The new process was effective for ensuring an efficient and effective process for patients who require high-cost controlled medications for pain management, reducing waste and providing a quality experience for the patient. As a result of the project, the new process has become policy and is now being used on other units in the institution for additional medications that requires CR and PA.
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Duncan, Ian, Terri L. Maxwell, Nhan Huynh, and Marisa Todd. "Polypharmacy, Medication Possession, and Deprescribing of Potentially Non-Beneficial Drugs in Hospice Patients." American Journal of Hospice and Palliative Medicine® 37, no. 12 (July 14, 2020): 1076–85. http://dx.doi.org/10.1177/1049909120939091.
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Patients frequently have comorbidities that when combined with their primary diagnosis qualifies the patient for hospice. Consequently, patients are at risk for polypharmacy due to the number of medications prescribed to treat both the underlying conditions and the related symptoms. Polypharmacy is associated with negative consequences, including increased risk for adverse drug events, drug–drug and drug–disease interactions, reduced functional status and falls, multiple geriatric syndromes, medication nonadherence, and increased mortality. Polypharmacy also increases the complexity of medication management for caregivers and contributes to the cost of prescription drugs for hospices and patients. Deprescribing or removing nonbeneficial or ineffective medications can reduce polypharmacy in hospice. We study medication possession ratios and rates of deprescribing of commonly prescribed but potentially nonbeneficial classes of medication using a large hospice pharmacy database. Prevalence of some classes of potentially inappropriate medications is high. We report possession ratios for 10 frequently prescribed classes, and, because death and prescription termination are competing events, we calculate prescription termination rates using Cumulative Incidence Functions. Median duration of antifungal and antiviral medications is brief (5 and 7 days, respectively), while statins and diabetes medications have slow discontinuance rates (median termination durations of 93 and 197 days). Almost all patients with a proton pump inhibitor prescription have the drug for their entire hospice stay. Data from this study identify those drug classes that are commonly deprescribed slowly, suggesting drug classes and diagnoses that hospices may wish to focus on more closely, as they act to limit polypharmacy and reduce prescription costs.
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Ofori-Asenso, Richard, Jenni Ilomaki, Andrea Curtis, Ella Zomer, Sophia Zoungas, and Danny Liew. "Patterns of Medication Dispensation for Multiple Comorbidities among Older Adults in Australia." Pharmacy 6, no. 4 (December 17, 2018): 134. http://dx.doi.org/10.3390/pharmacy6040134.
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Background: The increasing burden of chronic (medical) conditions (CCs) is a major issue for healthcare systems across the world. We aimed to examine the changes in the rate of medication dispensation for multiple CCs among Australians aged ≥65 years. Methods: A repeated cross-sectional study was performed using the 2013–2016 Pharmaceutical Benefits Scheme (PBS) data on reimbursed prescriptions for a 10% random sample of the Australian population. Twenty-two CCs were identified via the RxRisk-V tool. The yearly changes in the proportion of older adults dispensed medications for ≥2 CCs were determined through Poisson regression modelling using 2013 as the reference year. The occurrence of CC dyads and triads for which medications were dispensed within a 180-day window were characterised, and the observed and expected rate of medication dispensation for each CC dyad or triad were calculated to identify the top 15 combinations. Results: The proportion of older adults dispensed medications for ≥2 CCs remained stable from 2013 to 2016, at >79% in each year. The proportion who were dispensed medications for multiple CCs increased with age. No gender differences in the dispensation of medications for multiple CCs were observed. Over 60% had medications dispensed for ≥3 CCs. The most frequent CC dyad and triad for which medications were dispensed were dyslipidaemia + hypertension (38.6%) and dyslipidaemia + gastroesophageal reflux disease + hypertension (18.7%), respectively. For the majority of CC dyads and all triads examined, the observed rate of medication dispensation exceeded that expected by chance. Conclusions: A high proportion of older Australians are dispensed medications for multiple CCs, suggestive of multimorbidity. The results reiterate the need for increased research into understanding the causal mechanisms of multimorbidity to inform the design of cost-effective interventions.
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Eiman, Fatima, Arain Mudassar Iqbal, Suheryani Imran, Dayo Abdullah, Ghoto Muhammad Ali, Jabeen Ammarah, and Anwar Ramesha. "EVALUATION OF PHARMACOECONOMICS AND PRESCRIPTION TRENDS OF ANTIHYPERTENSIVE MEDICATIONS AT VARIOUS CLINICAL SETTINGS OF HYDERABAD, PAKISTAN." International Journal of Research in Ayurveda and Pharmacy 11, no. 5 (October 30, 2020): 94–98. http://dx.doi.org/10.7897/2277-4343.1105148.
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Pharmacoeconomics is the branch of health-economics where cost and outcomes are compared for patient’s treatment therapies and services in a health care system. Hypertension is one of the most common serious medical conditions in Pakistan and throughout the world. A large number of antihypertensive medications alone or in combinations are being prescribed. Pharmaco-economic studies are helpful in prescribing the most appropriate medication with required outcomes at minimum cost. Objective of study was to assess the prescription trends and cost-effectiveness among different classes of antihypertensive medications prescribed at different clinical setups of Hyderabad, Pakistan. A Prospective observational study was carried out at cardiac OPD of Liaquat University Hospital, Hyderabad from April 2018 to April 2019. According to inclusion and exclusion criteria, 400 prescriptions containing antihypertensive Drugs were collected via purposive sampling technique for pharmacoeconomic analysis during the study period. In Government setting, Monotherapy (83%) was more frequent than combination therapy (17%). The most frequent and the most cost-effective monotherapy was Enalapril maleate 5 mg having cost/day 4 Rs. In combination therapies, Lisinopril 20 mg + HTZ 12.5 mg was the most frequent. Spironolactone 50 mg + furosemide 40 mg was found to be the most cost-effective combination with cost/day 5 Rs. In private settings, the trends of antihypertensive monotherapy (75.5%) were more frequent than combination therapy (24.5%). The most frequent monotherapy was Telmisartan 40 mg while the most frequent antihypertensive combination was Amlodipine besylat 10 mg + Valsartan 160 mg. Metoprolol tartarate 100 mg and lisinopril 5 mg were cost-effective monotherapies with cost/day 5 Rs each and the combination of candesartancelexetil 16 mg + HTZ 12.5 mg was the most cost-effective. It is concluded from the current study that the prescription trends of antihypertensive medications were relatively cost-effective at Government setting but overall, the antihypertensive treatment cost was high which puts a substantial economic burden on patients.
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Karki, Sirisa, Gita Paudel, Roshan Chaurasia, Ashish Gautam, Sanjay Raj Baral, and Karma Murti Bhurtyal. "STUDY ON COST VARIATION OF ORAL ANTIHYPERTENSIVE MEDICATIONS AVAILABLE IN RETAIL STORES ACROSS CHITWAN." Journal of Chitwan Medical College 11, no. 3 (September 30, 2021): 41–44. http://dx.doi.org/10.54530/jcmc.467.
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Background: Antihypertensive medications reduce blood pressure and decrease cardiovascular disease morbidity and mortality. A number of antihypertensives with same formulation but different prices are available in the market. In the present study we aim to study such price variations of antihypertensive drugs currently available in the Nepalese market. Methods: We obtained the marked price of different antihypertensives manufactured in Nepal and India from various medicine stores within Chitwan from February to June 2021. Cost ratio (CR) and percentage cost variation (%CV) was calculated using Microsoft Office Excel-2019. Results: We observed a high percentage of cost variation in Amlodipine 5mg (CR: 3.33 %CV: 233.33) among Nepali and Losartan 50mg (CR: 32.31 %CV: 3131.47) among Indian antihypertensives. Conclusions: A wide percentage cost variation was observed among antihypertensive medications currently available in the Nepalese market. Regulatory bodies could address the issue to ensure affordability of essential antihypertensive medications.
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AYINBUOMWAN, STEPHEN, Abimbola Opadeyi, and Ambose Isah. "The current use of the artemisinin-based Combination Therapies in adult patients at a Tertiary Hospital, South-South Nigeria." Babcock University Medical Journal 5, no. 2 (December 31, 2022): 68–77. http://dx.doi.org/10.38029/babcockunivmedj.v5i2.145.
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Objective: The antimalarial preferences, tolerability, and cost of the Artemisinin-based combination therapies (ACTs) among adult patients and caregivers are largely understudied despite being the recommended treatment for Plasmodium falciparum. We, therefore, evaluated antimalarial preferences, tolerability, and cost of the ACTs among adult patients attending the University of Benin Teaching Hospital, Nigeria. Methods: This was a cross-sectional study conducted among adult patients and their caregivers at the University of Benin Teaching Hospital, Nigeria, using a semi-structured questionnaire. Their preferred antimalarial medication, previous use of antimalarial monotherapies, current ACT use; cost considerations, and adverse effects profile were sought. Result: Six hundred respondents were recruited with a mean age of 41.4±16.3years and M/F ratio of 1.4. The majority (88.0 %), reported that they had between 1-5 episodes of malaria fever in a year. Only 28.2% received doctors’ prescriptions while 85.8% purchased their antimalarial medications from a pharmacy. Sixty percent of the respondents used at least one ACT; mainly Artemether-Lumefantrine (AL) 312 (52.0%). Only 9.3% reported previous adverse effects with the ACTs with 4.0% of respondents discontinuing their medications. The mean (SD) cost of purchasing ACTs was 1,516.47±760.3 (3.65 USD) Naira. Conclusion: This study showed adult patients’ preference for the ACTs, especially Artemether-Lumefantrine despite some inclination towards antimalarial monotherapies and parenteral route. There was also a high rate of use of malaria presumptive treatment, but only a few reported adverse effects. There is a need to make ACTs affordable because the cost is still presently high for most Nigerians.
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Gallego, Gisselle, Susan J. Taylor, Paul McNeill, and Jo-anne E. Brien. "Public views on priority setting for High Cost Medications in public hospitals in Australia." Health Expectations 10, no. 3 (September 2007): 224–35. http://dx.doi.org/10.1111/j.1369-7625.2007.00439.x.
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Gellad, Walid, Maria Mor, Xinhua Zhao, Julie Donohue, and Chester Good. "Variation in Use of High-Cost Diabetes Mellitus Medications in the VA Healthcare System." Archives of Internal Medicine 172, no. 20 (November 12, 2012): 1608. http://dx.doi.org/10.1001/archinternmed.2012.4482.
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Mathew, Elsheba, Rajalakshmy Aiyappan, Mili M., Navaneetha N., Priyanka Shibu, and Rajeev Aravindakshan. "Prescription to practice in hypertension: a community experience in central Kerala." International Journal of Research in Medical Sciences 5, no. 11 (October 27, 2017): 4832. http://dx.doi.org/10.18203/2320-6012.ijrms20174929.
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Background: Control of blood pressure is a global challenge and non-adherence to hypertension medications is a public health concern. Patient, medication and system related factors can contribute to non-adherence. The study was to determine adherence to hypertension medications and to understand the barriers to adherence in an adult group in Pathanamthitta District of Central Kerala.Methods: A cross sectional study was conducted in a community setting in 2016, among 139 adults aged 30 years and above on treatment for hypertension for at least six months. Those with gestational hypertension, those having serious comorbid conditions and those unwilling to participate were excluded. The data sheet included basic demographic information and history related to hypertension. A content validated eight item questionnaire was used to assess reported adherence and scores classified level of adherence as good (8), moderate (6-<8) and poor (<6). The data was analyzed using SPSS. Chi square test of significance and multivariate regression analysis were done. P<0.05 was considered statistically significant.Results: The participants were in the age group 34-91 years, 50.4% belonging to 50-69 years, and 75.5% were females. Adherence to hypertension medications was good in 49.6%, moderate in 31.7% and poor in 18.7%. The most common factors reported to contribute to non-adherence were forgetfulness (70.5%), high cost of medications (51.8%), and symptom-free state (27.3%).Conclusions: Adherence was good in less than half the study participants and poor in almost one-fifth. Forgetfulness and high medication costs were the most commonly reported barriers. These findings highlight the importance of individuals, families and health service, joining hands to tackle the public health problem of non-adherence to hypertension medications.
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Caucat, Marie, Alice Zacarin, Vanessa Rousseau, Jean-Louis Montastruc, and Haleh Bagheri. "The Cost of Potentially Inappropriate Medications in Nursing Homes in West Occitanie." Pharmacy 8, no. 1 (March 11, 2020): 39. http://dx.doi.org/10.3390/pharmacy8010039.
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Introduction: As of 2019, people older than 65 years represent 20% of the French population. Despite several guidelines suggesting to avoid potentially inappropriate medication (PIM) use in elderly, the prevalence of their prescription remains high (25%). Furthermore, PIM could lead to preventable adverse drug reactions (ADRs). The main objective of this study was to determine the direct cost of PIM in older persons living in residential care homes for the elderly (nursing homes). A secondary objective was to assess the potential impact of PIM deprescribing on drug-related health care costs. Methods: We undertook a multicenter, retrospective study in 19 care homes for the elderly including 1240 residents. The analysis of prescriptions was carried out according to the European EU(7) PIM list. The cost of each drug was estimated according to the French Medication Insurance database. Furthermore, patient’s comorbidities were studied using Charlson’s comorbidity index. In order to estimate the economic impact of PIM, we used the list of alternative appropriate drugs suggested by EU(7) PIM list and French National Health Authority. An incremental cost per patient was calculated by the difference in costs between PIMs and alternative drugs. Results: A total of 7768 lines of drug prescriptions were analyzed. The mean age was 87.6 ± 7.6 years. About 70% (n = 872) of residents received more than five drugs. We identified 959 residents (77.3%) with at least one PIM. The mean cost of PIM was 0.58 euros versus 0.48 euros for alternatives. PIM substitution by alternatives led to save 12 centimes/resident/day. The mean cost of prescription with PIM was 2.8 euros per resident per day (28% of the overall cost of prescription). According to these results, more than 25 million euros can be overall saved for aged persons living in nursing homes for the older people in France per year. Conclusion: The prevalence of PIMs among the elderly in nursing homes is high and leads to a significant cost. Deprescribing of these medications could decrease both drug misuse and cost of drug prescription. Further research is needed to estimate the overall cost of PIM exposure outcomes, taking into account the ADRs leading to hospitalization.
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Howlett, Moninne, Anne Fitzpatrick, and Terence Prendiville. "P18 Provocation of paediatric hearts – a safe and smart solution." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e15.1-e15. http://dx.doi.org/10.1136/archdischild-2020-nppg.27.
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AimsProvocation challenges are used to diagnose certain inherited life-threatening cardiac conditions; treatment can prevent malignant arrhythmias and sudden death. Provocation medications are administered to unmask pathognomic conduction characteristics on real-time electrocardiography. Pre-prepared rescue medications are administered should a ventricular arrhythmia be unintentionally provoked. These high-risk medications, in line with safety agency recommendations, should be delivered using smart-pump technology.1 They are also often unlicensed and expensive.2 We investigated the utilisation of smart-pumps and development of a guideline to optimise medicines management and safety of these procedures in an Irish tertiary paediatric hospital.MethodsPublished literature and current practices, including those in other paediatric and adult hospitals in Ireland and the UK, were reviewed to ascertain appropriate dosing and administration in the paediatric population.3 4 Multi-disciplinary input from nursing, cardiology, pharmacy and biomedical engineering was sought in guideline development.ResultsEvidence for such challenges in paediatrics is sparse. Suitable dosing was agreed and an indication-specific smart-pump drug library created. The ‘PCA Therapy’ module was employed to deliver repeated weight-based doses of the provocation medication (Ajmaline) in a controlled and timely manner; the rescue medication (Isoprenaline) was programmed as a continuous infusion. An auxillary calculator was developed in Microsoft Excel® to direct staff on preparation of both infusion solutions and bolus doses of medications to be manually administered (Magnesium and Isoprenaline). In 2017, relevant staff were trained, and the ‘Ajmaline Challenge’ guideline was approved and implemented in the Cardiac Catherisation Laboratory (CCL) and Cardiac Day Unit. Estimated cost savings of €19,400 were realised between January 2017 - October 2018 due to reduced wastage of unused medications. Further savings are likely due to decreased utilisation of the CCL.ConclusionMulti-disciplinary collaboration and health technology can improve the safety and cost-effectiveness of high-risk cardiac diagnostic procedures in the paediatric setting. Similar processes for other provocation challenges are under development.ReferencesInstitute for Safe Medication Practices, ISMP. 2018–2019 Targeted Medication Safety Best Practices for Hospitals 2018 [Available from: https://www.ismp.org/sites/default/files/attachments/2017-12/TMSBP-for-Hospitalsv2.pdf [Accessed: June 2019]European Commission. State of Paediatric Medicines in the EU - 10 years of the EU Paediatric Regulation 2017 [Available from: https://ec.europa.eu/health/sites/health/files/files/paediatrics/docs/2017_childrensmedicines_report_en.pdf [Accessed: June 2019]McMillan MR, Day TG, Bartsota M, et al. Feasibility and outcomes of ajmaline provocation testing for Brugada syndrome in children in a specialist paediatric inherited cardiovascular diseases centre. Open Heart 2014;1:e000023.Rolf S, Bruns HJ, Wichter T, et al. The ajmaline challenge in Brugada syndrome: diagnostic impact, safety, and recommended protocol. Eur Heart J. 2003;24:1104–12.
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Moss, Brandon P., and Jeffrey A. Cohen. "The emergence of follow-on disease-modifying therapies for multiple sclerosis." Multiple Sclerosis Journal 25, no. 12 (May 10, 2019): 1560–65. http://dx.doi.org/10.1177/1352458519845106.
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Medication prices are a major contributor to the high cost of care for multiple sclerosis. Three generic glatiramer acetate products have regulatory approval in North America, Europe, or Latin America. The pending expiration of patents for other disease-modifying therapies for relapsing multiple sclerosis creates the opportunity for development and regulatory approval of additional follow-on alternatives (generics or biosimilars), potentially providing lower prices and cost savings to payors and patients. However, the complexities of development, regulatory approval, and marketing of follow-on products have some important differences compared to those of new drugs. This topical review provides background and a status update on the development of follow-on disease-modifying medications to treat multiple sclerosis.
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Lewis, Steven. "Funding the New Biologics – Public Policy Issues in Drug Formulary Decision Making." Canadian Journal of Gastroenterology 16, no. 12 (2002): 869–72. http://dx.doi.org/10.1155/2002/525819.
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One function of drug formularies is to allow health care providers to exert some control over spending. Decisions about whether to include a given medication in a formulary are based on estimates of its costs and effectiveness, relative to other treatment strategies. These decisions are made from a societal perspective, as opposed to that of individual patients, which sometimes results in conflicts. The clinical response to a medication often varies widely among subjects, which means that a small subgroup of patients might benefit dramatically, while others with the same disease do not. The result would be that a drug might appear not to be cost effective in an economic analysis, even though it is of proven value for some patients. New and innovative medications are assessed according to high standards of cost effectiveness, even though established treatments are wasteful of valuable health care resources. Moreover, quality-adjusted life-years (QALYs) discriminate against certain patient groups, including those with diseases that are associated with a high morbidity but a low mortality. Such patients often incur high indirect costs, including loss of employment income and costs incurred by family caregivers that QALYs do not reflect. Therefore, even though QALYs are transparent and widely applicable, they are not necessarily appropriate in the evaluation of a particular therapeutic intervention. A new paradigm should be developed for evaluating emerging therapies. An example would be a risk-sharing approach, whereby the pharmaceutical industry and public insurers share in the costs and rewards of introducing new treatments. This would have implications for the prices charged for new medications.
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Dela-Pena, Jacqueline C., Katie A. Eschenburg, Vincent W. LaRocca, Dipale Patel, and Shannon M. Hough. "Financial Impact of an Automated Oncology Dose-Rounding Initiative: One-Year Analysis." JCO Clinical Cancer Informatics, no. 5 (August 2021): 805–10. http://dx.doi.org/10.1200/cci.21.00024.
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PURPOSE Infusion drugs are regarded as one of the high-cost health care expenditures. One approach to decrease drug expenditures is by dose-rounding biologics and cytotoxic agents. The Hematology/Oncology Pharmacy Association recommends that biologic and cytotoxic agents are rounded to the nearest vial size if they are within 10% of the ordered dose. The purpose of this initiative is to determine the impact of an automated dose-rounding algorithm on drug expenses. METHODS The dose-rounding algorithm was developed and integrated into the computerized physician order entry system for automated dose rounding to minimize impact on current workflow and to reduce medication errors. Twenty-four medications were preselected for dose rounding and included in the analysis. Ordered doses were automatically rounded to the nearest vial size if the dose was within 10% of the original dose. Prescribers then either reviewed and signed the rounded dose or manually entered the nonrounded dose. Cost savings were calculated as drug expense savings from doses rounded down. RESULTS From July 2018 to June 2019, 10,206 doses of the selected medications were administered. Dose rounding occurred in 5,069 doses (49.7%). All 24 medications within the initiative were administered within the time of analysis. Of the rounded doses administered, 2,516 (49.6%) were rounded down to a commercially available vial size. Using wholesale acquisition cost pricing, the drug expense savings was approximately $3.6 million US dollars (USD). The medications with the highest savings were trastuzumab and ipilimumab, with annual savings of $756,780 USD and $494,517 USD, respectively. CONCLUSION The automated dose-rounding algorithm at Michigan Medicine reduced drug expenditures substantially, and its integration within the computerized physician order entry system had minimal impact on current workflow.
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Nasir, Morshed, A. S. M. Salauddin Chowdhury, and Tahmina Zahan. "Self-medication during COVID-19 outbreak: a cross sectional online survey in Dhaka city." International Journal of Basic & Clinical Pharmacology 9, no. 9 (August 25, 2020): 1325. http://dx.doi.org/10.18203/2319-2003.ijbcp20203522.
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Background: Self-medication is a common practice in Bangladesh as it provides a low-cost alternative for people, which involves inappropriate and injudicious use of medicines treat self-recognized symptoms by the people.Methods: A cross sectional online survey was conducted on 626 citizens by structured questionnaires during COVID-19 outbreak from April to May 2020 in Dhaka city, to observe the prevalence, pattern and sources of self-medication among the respondents with high socio-economic standings and education.Results: The prevalence of self-medication amid the outbreak of COVID-19 was 88.33% and only 179 (28.59%) took medication with doctors’ advice and remaining 447 (71.40%) respondents took the drugs as “self-medication” by other sources. The most frequently used prescription-only drug during the outbreak were ivermectin (77.15%), azithromycin (54.15%), doxycycline (40.25%). The common symptoms for which the respondent took self-medications were fever, throat pain, dry-cough and total 105 (16.77%) respondents took medications without having any symptoms. Almost 355 (85.33%) had taken medication without doing any test for COVID-19. This could be due to unusual distress, caused by high self-awareness of their health and buying capacity of medication.Conclusions: The study revealed the causes of self-medication as news of spread, effects and remedies in media channels, internet; mental stress of lockdown and isolation, insecurity and panic about scarcity of drug and healthcare support. High risks of developing antibiotic resistance, adverse drug reactions and financial loss was predictable with absence of strict regulatory enforcement to protect people and proper utilization resources during COVID-19 outbreak in Dhaka city.
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Wong, William Bruce, Arpamas Seetasith, Anna Hung, and Leah L. Zullig. "Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs." PLOS ONE 18, no. 1 (January 19, 2023): e0280570. http://dx.doi.org/10.1371/journal.pone.0280570.
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Background Insurers manage the cost of specialty medicines via rebates, however it is unclear if the savings are passed on to patients, and whether reducing rebates may lead to changes in patient out-of-pocket (OOP) costs and medication adherence. This study examined two drug classes to understand the impact of reducing list prices to net prices, via lower-priced national drug codes (NDCs) or authorized generics, on patient OOP costs and adherence. Methods This retrospective analysis assessed IQVIA PharMetrics ® Plus adjudicated medical and pharmacy claims for commercially insured patients. Patient OOP costs per prescription and payer drug costs were assessed for evolocumab or alirocumab (proprotein convertase subtilisin/kexin type 9 inhibitors [PCSK9is]) or velpatasvir/sofosbuvir or ledipasvir/sofosbuvir (hepatitis C virus [HCV] medications). For PCSK9is and HCV medications, the original and lower-priced versions were compared. Adherence was estimated based on proportion of days covered (PDC) (PCSK9is) and receipt of full treatment regimen (HCV medications). Results In total, 10,640 patients were included (evolocumab, 5,042; alirocumab, 1,438; velpatasvir/sofosbuvir, 2,952; ledipasvir/sofosbuvir,1,208). After list price reductions, mean payer drug costs decreased by over 60%, while patient OOP cost reductions ranged from 14% to 55% (evolocumab: 55%, p < 0.01; alirocumab: 51%, p < 0.01; velpatasvir/sofosbuvir: 30%, p < 0.01; ledipasvir/sofosbuvir: 14%, p = 0.03). Patients with coinsurance as the largest contributor to their OOP costs had the largest reductions in OOP costs, ranging from adjusted, mean values of US$135 to US$379 (>60% reductions). Six-month PDC for PCSK9is and proportion receiving full HCV treatment regimen were high with the original versions and did not substantially differ with the new, lower-priced versions. Conclusions Reducing list prices to approximate net prices (as a proxy for reducing rebates) resulted in lower patient OOP costs, particularly for those with coinsurance. Our findings suggest that future reduction of rebates may assist in patient affordability, although additional transparency is needed.
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McRae, Ian, Kees van Gool, Jane Hall, Laurann Yen, and Michael Wright. "Failure to access prescribed pharmaceuticals by older patients with chronic conditions." Australian Health Review 44, no. 2 (2020): 270. http://dx.doi.org/10.1071/ah18146.
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Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions. Methods Data from 267086 participants in the Sax Institute’s 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS ‘safety net’. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates. Results Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence. Conclusions As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications. What is known about the topic? Previous studies have shown patients’ concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments. What does this paper add? This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions. What are the implications for practitioners? Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those general patients who have not reached the safety net, and they can be aware that patients from homes where English is not spoken and patients with high levels of psychological distress are also likely to have low adherence without intervention.