Affording Prescription Medications Research Articles

Patient preferences and willingness-to-pay for community pharmacy-led Medicare Part D consultation services: A discrete choice experiment.

Community pharmacies currently offer Medicare Part D consultation services, often at no-cost. Despite facilitating plan-switching behavior, identifying potential cost-savings, and increasing medication adherence, patient uptake of these services remains low. To investigate patient preferences for specific service-offering attributes and marginal willingness-to-pay (mWTP) for an enhanced community pharmacy Medicare Part D consultation service. A discrete choice experiment (DCE) guided by the SERVQUAL framework was developed and administered using a national online survey panel. Study participants were English-speaking adults (≥65 years) residing in the United States enrolled in a Medicare Part D or Medicare Advantage plan and had filled a prescription at a community pharmacy within the last 12 months. An orthogonal design resulted in 120 paired-choice tasks distributed equally across 10 survey blocks. Data were analyzed using mixed logit and latent class models. In total, 540 responses were collected, with the average age of respondents being 71 years. The majority of respondents were females (60%) and reported taking four or more prescription medication (51%). Service attribute levels with the highest utility were: 15-min intervention duration (0.392), discussion of services+a follow-up phone call (0.069), in-person at the pharmacy (0.328), provided by a pharmacist the patient knew (0.578), and no-cost (3.382). The attribute with the largest mWTP value was a service provided by a pharmacist the participant knew ($8.42). Latent class analysis revealed that patient preferences for service attributes significantly differed by gender and difficulty affording prescription medications. Quantifying patient preference using discrete choice methodology provides pharmacies with information needed to design service offerings that balance patient preference and sustainability. Pharmacies may consider providing interventions at no-cost to subsets of patients placing high importance on a service cost attribute. Further, patient preference for 15-min interventions may inform Medicare Part D service delivery and facilitate service sustainability.

The Financial Burden of CKD: The Medication Edition.

The mounting out-of-pocket expenses of prescription medications for people living with CKD and their comorbid conditions can be overwhelming. When you consider patients with low and middle incomes, it can create worsening health outcomes because of the lack of available resources to assist them in this area. No one should have to make life-altering decisions about affording prescription medications and managing their quality of life. One day at work in 2003, I was feeling exhausted and lethargic. I went to the medical department to get checked out. The attending nurse asked me if I had ever had my glucose levels checked. Her question was foreign to me, because I had not a clue to what she was alluding to. After explaining what glucose levels were, she took blood from my finger, and her next comment changed my life. The nurse told me my glucose level was 758 and I needed to go directly to the nearest hospital's emergency room. Upon being seen by the emergency room physician, he told me my A1c was 11.7 and diagnosed me with type 2 diabetes. Furthermore, the physician referred me to an endocrinologist for follow-up care. My physician told me I needed to lose weight and eat a healthier diet, but she never mentioned diabetes was the leading cause of kidney disease. The doctor also prescribed three different medications to help manage my diabetes:

Financial Toxicity Intervention Improves Quality of Life in Hematologic Malignancy Patients

Background: Financial toxicity (FT) has been consistently demonstrated to a be a major contributor to morbidity and mortality in a variety of cancers. However, the vast majority of research examining this issue has been in solid tumors, and there has been less investigation of how this concept applies in malignant hematology and even fewer studies looking at an interventional model. This pilot study attempts to identify patients at high-risk due to FT in a busy clinical environment and improve clinical outcomes with comprehensive intervention. Methods: All patients seen at the Malignant Hematology Clinic at the Levine Cancer Institute, a tertiary hospital-based specialty practice, were surveyed at their visits over a six-month period. All patients were aged ≥18 years and diagnosed with hematologic malignancy or bone marrow failure syndrome. The survey consisted of the PROMIS Global-10 measure and two questions from the COST measure. FT was defined as scoring 5 or less (maximum: 10) in agreement with the COST questions: "I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment" and "I am satisfied with my current financial situation." Patients with FT were entered into the interventional cohort and scheduled for a visit with a nurse navigator where they completed a standardized worksheet to identify gaps in care and opportunities for grant funding/other assistance. Patients were seen by a clinical pharmacist for copay review and discussion of assistance programs. Finally, patients were offered the services of a community pro-bono financial planner for help with budgeting, asset management, and general financial advice. Patients were tracked longitudinally for assistance provided, changes in PROMIS scores, and clinical outcomes. Categorical variables, including responses to survey questions, were summarized with frequencies and proportions, while continuous variables were summarized with medians and ranges. Correlation of FT screening scores and COST scores was assessed with Spearman's correlation. Baseline versus post-intervention PROMIS scores were compared with paired t-tests, while McNemar tests for agreement were used to compare ER and IP utilization 3 months prior versus post intervention. Results: A total of 107 patients were included in the intervention. Specific characteristics of the intervention population are listed in Table 1. FT screening scores were found to correlate with the full COST measure (Spearman correlation = 0.45, p <.001). Patients in the intervention cohort had high rates of noncompliance due to inability to afford prescription medications (16.8%), OTC medications (15.9%), and doctor visits (6.5%). In order to pay for their care, patients reported reducing spending on food and clothing (48.6%), using savings to cover OOP expenses (51.4%), and partially filling prescriptions (11.2%) (Table 2). In terms of the intervention, 37.4% of patients were found to qualify for and were helped to obtain grants from external foundations. The median value of these grants was $850 (range: $100-$17,850). Through manufacturer's assistance and other programs, the clinical pharmacy team was able to obtain free or greatly reduced cost medications for the qualified patients at a median retail value of $197,158 (range: $29,909-$639,801). Gas cards, food pantry assistance, and transportation assistance were also supplied to patients who qualified at a median value of $300 ($100-$300). 58 patients (54.2%) expressed interest and were scheduled with a pro-bono financial counselor. The intervention resulted in statistically significantly higher quality of life when measured by PROMIS physical and mental health scores, compared to baseline scores (Table 3) (all p <.001). There was no significant difference found when looking at patients with at least one ER visit 3 months prior and post intervention (10.3% vs 6.5% p=.317). There was no difference between inpatient visits/days pre and post intervention. Conclusions: Using a quick screening method for FT in a busy clinical environment is feasible and allows identification of an extremely high-risk population. Intervening on FT in a comprehensive way including navigators, pharmacists, and financial counselors is effective and leads to increased quality of life. Disclosures Knight: Foundation for Financial Planning: Research Funding. Ai:Celgene: Speakers Bureau; Incyte: Speakers Bureau. Chojecki:Incyte: Research Funding; Novartis: Other: Investigator Meeting Attendance. Copelan:Amgen: Membership on an entity's Board of Directors or advisory committees. Grunwald:Forma Therapeutics: Research Funding; Premier: Consultancy; Premier: Consultancy; Celgene: Consultancy; Abbvie: Consultancy; Pfizer: Consultancy; Abbvie: Consultancy; Trovagene: Consultancy; Premier: Consultancy; Astellas: Consultancy; Astellas: Consultancy; Genentech/Roche: Research Funding; Celgene: Consultancy; Celgene: Consultancy; Janssen: Research Funding; Merck: Research Funding; Cardinal Health: Consultancy; Amgen: Consultancy; Amgen: Consultancy; Agios: Consultancy; Merck: Consultancy; Merck: Consultancy; Amgen: Consultancy; Merck: Consultancy; Cardinal Health: Consultancy; Pfizer: Consultancy; Cardinal Health: Consultancy; Daiichi Sankyo: Consultancy; Astellas: Consultancy; Daiichi Sankyo: Consultancy; Trovagene: Consultancy; Pfizer: Consultancy; Forma Therapeutics: Research Funding; Genentech/Roche: Research Funding; Genentech/Roche: Research Funding; Janssen: Research Funding; Forma Therapeutics: Research Funding; Trovagene: Consultancy; Incyte: Consultancy, Research Funding; Incyte: Consultancy, Research Funding; Incyte: Consultancy, Research Funding; Agios: Consultancy; Daiichi Sankyo: Consultancy; Agios: Consultancy; Abbvie: Consultancy.

Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study

Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (-1·4 score, 95% CI -2·5 to -0·3; p=0·01), trust between neighbours (-0·7, -1·2 to -0·3; p=0·003), higher education level (-1·9, -2·9 to -0·8, p<0·001), and higher social support (-1·1, -2·0 to -0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing. Heart and Stroke Foundation of Canada, Canadian Partnership Against Cancer, Canadian Institutes for Health Research.

Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011.

Disabled Americans who qualify for Medicare coverage typically have multiple chronic conditions, are highly dependent on effective drug therapy, and have limited financial resources, putting them at risk for cost-related medication nonadherence (CRN). Since 2006, the Part D benefit has helped Medicare beneficiaries afford medications. To investigate recent national trends in medication affordability among this vulnerable population, stratified by morbidity burden. We estimated annual rates of medication affordability among nonelderly disabled participants in a nationally representative survey (2006-2011, n=14,091 person-years) using multivariate logistic regression analyses. Survey-reported CRN and spending less on other basic needs to afford medicines. In the 6 years following Part D implementation, the proportion of disabled Medicare beneficiaries reporting CRN ranged from 31.6% to 35.6%, while the reported prevalence of spending less on other basic needs to afford medicines ranged from 17.7% to 21.8%. Across study years, those with multiple chronic conditions had consistently worse affordability problems. In 2011, the prevalence of CRN was 37.3% among disabled beneficiaries with ≥ 3 morbidities as compared with 28.1% among those with fewer morbidities; for spending less on basic needs, the prevalence was 25.4% versus 15.7%, respectively. There were no statistically detectable changes in either measure when comparing 2011 with 2007. Disabled Medicare beneficiaries continue to struggle to afford prescription medications. There is an urgent need for focused policy attention on this vulnerable population, which has inadequate financial access to drug treatments, despite having drug coverage under Medicare Part D.

Chronic pain among homeless persons: characteristics, treatment, and barriers to management

BackgroundLittle information is available on the problem of chronic pain among homeless individuals. This study aimed to describe the characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use among a representative sample of homeless single adult shelter users who experience chronic pain in Toronto, Canada.MethodsParticipants were randomly selected at shelters for single homeless adults between September 2007 and February 2008 and screened for chronic pain, defined as having pain in the body for ≥ 3 months or receiving treatment for pain that started ≥ 3 months ago. Cross-sectional surveys obtained information on demographic characteristics, characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use. Whenever possible, participants' physicians were also interviewed.ResultsAmong 152 homeless participants who experienced chronic pain, 11 (8%) were classified as Chronic Pain Grade I (low disability-low intensity), 47 (32%) as Grade II (low disability-high intensity), 34 (23%) as Grade III (high disability-moderately limiting), and 54 (37%) as Grade IV (high disability-severely limiting). The most common self-reported barriers to pain management were stress of shelter life, inability to afford prescription medications, and poor sleeping conditions. Participants reported using over-the-counter medications (48%), street drugs (46%), prescribed medications (43%), and alcohol (29%) to treat their pain. Of the 61 interviewed physicians, only 51% reported treating the patient's pain. The most common physician-reported difficulties with pain management were reluctance to prescribe narcotics due to the patient's history of substance abuse, psychiatric comorbidities, frequently missed appointments, and difficulty getting the patient to take medications correctly.ConclusionsClinicians who provide healthcare for homeless people should screen for chronic pain and discuss barriers to effective pain management with their patients.

Socioeconomic disparities for hearing‐impaired children in the united states

This study aims to evaluate disparities in socioeconomic status and healthcare utilization in hearing-impaired children using a nationally representative sample. Cross-sectional analysis of stacked data from the 1997 to 2003 National Health Interview Survey, a voluntary U.S. household survey of the National Center for Health Statistics. Children were grouped according to three levels of hearing ability based on parental response to perceived hearing status. χ(2) and analysis of variance (ANOVA) models tested the association of individual sociodemographic variables with hearing status. Multivariate regression analyses examined the association of hearing impairment with family income, poverty status, and utilization of routine and specialty health services. The total sample consisted of 76,012 children, of whom 2.6% had some hearing loss and 0.43% had marked hearing loss. Families of hearing-impaired children were more likely to report poorer health status, have Medicaid, live in single-mother households, and live below the poverty level (P < .01). After adjusting for confounders, children with mild and marked hearing impairment were less likely to afford prescription medications (odds ratio [OR] = 1.89, 95% confidence interval [CI], 1.44-2.48 [mild]; OR = 2.72, 95% CI, 1.73-4.29 [marked]) and less likely to have access to mental health services (OR = 3.26, 95% CI, 2.41-4.69 [mild]; OR = 2.62, 95% CI, 1.34-5.12 [marked]) or dental services (OR = 1.65, 95% CI, 1.36-2.02 [mild]; OR = 1.62, 95% CI, 1.09-2.41 [marked]). No difference was identified for access to routine/sick health services. Compared with families of children without hearing loss, families of hearing-impaired children live closer to the poverty level and utilize some medical services with less frequency. Further identification of causal relationships between familial socioeconomic status and childhood hearing loss may help direct policy initiatives designed to mitigate healthcare disparities and improve access to services for hearing-impaired children.

Influence of race and ethnicity on access to care among children with frequent ear infections

ObjectiveDetermine the impact of racial/ethnic disparities on access to care for children with frequent ear infections (FEI). Identify disparities to target for intervention. Study DesignCross-sectional analysis of national database. SettingAcademic medical center. Subjects and MethodsThe National Health Interview Survey (1997 to 2006) was utilized to identify children with FEI (defined as three or more ear infections in the preceding year). Age, sex, race/ethnicity, income level, and insurance status were extracted. Access to care was measured by ability to afford medical care and prescription medications, specialist visitation, and emergency department visits. Multivariate analysis determined the influence of demographic variables on the ability to access health care resources. ResultsAn annualized population of 4.65 ± 0.08 million children reported FEI. Overall, 3.7 percent could not afford care, 5.6 percent could not afford prescriptions, and only 25.8 percent saw a specialist. A larger percentage of the black (42.7%) and Hispanic children (34.5%) with FEI were below the poverty level, versus white children (12.4%; P < 0.001); 18.2 percent of Hispanic children were uninsured, versus 6.5 percent of white children (P < 0.001). On multivariate analysis, children with FEI that were black or Hispanic had increased odds ratios relative to white children for 1) not being able to afford prescription medications (odds ratios [OR] 1.76 and 1.47, respectively; P < 0.002); 2) not being able to see a specialist (OR 1.62 and 1.86, respectively; P < 0.001); and 3) visiting the emergency department (OR 2.50 and 1.32, respectively; P < 0.001). ConclusionRacial/ethnic disparities among children with FEI significantly influence health care resource access and utilization. These disparities should be targeted for intervention.

Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Patients struggling to afford prescription medications were referred to a clinical pharmacist by the physician or nurse practitioner for medication assistance evaluation. Once patients were deemed eligible, the pharmacist assisted in the PAPs completion process, maintained detailed records, and aided in recovery of refills. Patients paid $5 per application to cover office supply costs. An annual retrospective review was performed each December to evaluate the monetary value of free medications provided to patients during this 24-month period. One hundred forty-two applications were completed, enrolling 31 patients in 22 PAPs. Patients received $138,400 worth of medications; the clinic collected $710 in fees. Antihypertensive, antidepressant, lipid-lowering, antiplatelet, and proton pump inhibitor medications were most frequently prescribed and represented 74% of the total monetary value of free medications provided to patients. Clopidogrel (Plavix) and esomeprazole (Nexium) were the most commonly requested medications, representing 16% of the monetary value. PAPs offer an avenue to obtain medications when cost may lead to non-adherence. PAP services helped rurally isolated Alabamians receive needed therapies they otherwise likely would not have purchased. Similar programs offering assistance services for merely cardiovascular products would provide a substantial public health impact. Providers interested in initiating similar services should identify a program coordinator, designate a private location for patient interviews, and develop systems to ensure patients receive their PAP medications.

Effect of racial differences on ability to afford prescription medications

The association of race with not filling prescription medications because of cost for African-American and white patients 65 years or older was examined. African-American and white patients age 65 years or older were recruited from the practices of 48 Alabama primary care physicians participating in the Alabama Nonsteroidal Antiinflammatory Drug Patient Safety Study. All eligible patients were asked questions related to their ability to pay for prescription medications, comorbidities, insurance status, and socioeconomic status. Baseline and follow-up telephone surveys were completed between August 2005 and April 2006. Mediation analysis was conducted to determine whether patients' perceived income inadequacy mediated the association between race and not filling medications using staged logistic regression models and adjusting for age, comorbidities, and traditional markers of socioeconomic position (income, education, and insurance status). Of 399 participants, 32% were African-American, 74% were women, and 53% had an annual household income of <$15,000. Patients not filling prescription medications were more likely to be African-American (50% versus 25%) and to report inadequate income to meet basic needs (61% versus 17%) (p < 0.001 for both comparisons). After adjusting for all covariates except the mediator, the odds ratio (OR) for African Americans not filling a prescription medication was 2.3 when compared with white patients. Adding the mediator (perceived income inadequacy) to the model reduced the OR to 1.4. African Americans reported markedly greater difficulty in affording prescription medications than did white patients, even after accounting for income, education, health insurance status, and comorbidities. The inability of African Americans to afford prescription medications may be better predicted by perceived income inadequacy than more traditional measures of socioeconomic status.

Frequent Outpatient Contact and Decreasing Medication Affordability in Patients With Diabetes From 1997 to 2004

Despite significant changes in treatment standards for diabetes, there has been little improvement in overall rates of metabolic control (1–5). In recent years, diabetes medical regimen complexity has also increased markedly, with the proportion of U.S. patients taking five or more prescription medicines nearly doubling (from 18 to 30%) from 1994 to 2003 (6). Given the persistent difficulty in achieving ideal metabolic control and the increasing complexity of medical care, further insight into current diabetes outpatient management is required. We used data from the National Health Interview Survey (NHIS) to examine U.S. annual trends in diabetes care from 1997 to 2004. The NHIS is an annual nationwide in-person household survey conducted by the Census Bureau that includes an in-depth adult health care access and utilization survey. Sampled adults were asked about demographic and socioeconomic information, diagnosed conditions, self-reported ability to afford prescription medications in the prior year, perceived barriers to obtaining clinic appointments (e.g., long waits for appointments, difficulty making appointments, difficulty reaching the clinic by phone), and frequency of outpatient clinical contact (excluding overnight hospitalizations, telephone calls, and emergency room, dental, or home visits). Response rates over this 8-year period varied from 80.8 to 90.3%. We limited our analyses to adults who self-identified as having a diagnosis of nongestational diabetes. We created a single independent variable for year (numbered 1–8) and used logistic regression for dichotomous and linear …

Attention-Deficit/Hyperactivity Disorder in School-Aged Children: Association With Maternal Mental Health and Use of Health Care Resources

To investigate the association between the mental health status of mothers and attention-deficit/hyperactivity disorder (ADHD) in their school-aged children and to characterize the health care access and utilization of families affected by ADHD. Survey logistic regression procedures were used to investigate the association between activity-limiting mental health conditions in mothers and ADHD in their school-aged children using 1998 National Health Interview Survey data. A total of 9529 mother-child dyads were included in the final analysis. The prevalence of ADHD among children aged 4 to 17 years was 6.3%. Survey logistic regression statistics revealed an association between an activity-limiting depression, anxiety, or emotional problem in mothers and ADHD in their children. This association persisted after controlling for the gender, age, and race of the child; household income (as a function of the 1997 poverty level); and type of family structure as reported by the mother (adjusted odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.2-8.1). Mothers of a child with ADHD were 13 times more likely to have consulted with a mental health professional about their child's health within the past year despite reporting an inability to afford prescription medications (OR: 3.3; 95% CI: 2.2-4.9) and mental health care (OR: 7.4; 95% CI: 4.6, 11.8) for the child. Maternal mental health is significantly associated with the presence of ADHD in school-aged children. This finding further supports a link between maternal mental health and behavioral outcomes in children. Health care utilization and access findings support a family-oriented system of care.