Prescription Drug Costs Research Articles

Evaluation of public's knowledge, attitude and experiences towards the generic medications in building healthcare policy.

The increasing cost of prescription drugs has high concern and associated with medication nonadherence and adverse health outcomes. The use of generic prescription drugs by the patients depends on if recommended by competent healthcare providers. Generic medicines, which are cheaper and bioequivalent to brand-name drugs, offer an opportunity to reduce healthcare expenditures of Saudi Arabia's healthcare system as per the Vision 2030 plan. Therefore, the current study was conducted to assess the population awareness, attitude and perception towards the generic medications particularly those locally manufactured in Saudi Arabia. We managed a cross-sectional, questionnaire-based study and included indices like demographic sections, knowledge of generic medications, perception of generic medication use, and previous experience. Data was collected over 12 weeks from February 2022 to April 2022 using an online survey tool. A study of 462 participants found that the majority were male (54.97%), young (55.4%), with a graduate or post-graduate degree (73.5%) and employed (43.29%). The majority reported good health, with 75.5% reporting good health. The study found significant differences in knowledge about generic drugs, their country of origin, and their benefits and utility. Most participants had positive attitudes towards generic medications, with 45% believing they are as effective as those from other countries. The study also revealed a significant difference in participants' experience and usage of medications particularly satisfaction to health outcome. Enhancing healthcare professionals' perceptions of generics can positively influence patient/consumer opinions and trust in generic medicines. Patients' high trust in prescribing physicians also influences these opinions, as their opinions can influence patient/consumer opinions.

Healthcare resource utilisation and cost of care of systemic inflammation in individuals with atherosclerotic cardiovascular disease and chronic kidney disease

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is a chronic disease, progressed by localised or systemic inflammation (SI). Chronic kidney disease (CKD) facilitates the presence of SI and is associated with an increased risk of ASCVD. Previous studies have estimated that 1–2% of the population in Western countries suffer from both conditions. Purpose To investigates the healthcare costs and resource utilisation for individuals diagnosed with ASCVD and CKD, with or without SI. Method The study applied data from the Danish national health and administrative registries from 1994-2022. Patients with ASCVD were identified by ICD-10 codes. CKD was identified by eGFR [15-59mL/min/1.73m2], in the Register of Laboratory Results for Research (RLRR). The latter date of diagnosis of the two diseases were used as index date. CRP-test results were extracted from RLRR. Individuals with conditions associated with CRP-levels and tests observed in association with CVD events or antibiotic/antiviral drug use were excluded. Individuals with at least two valid CRP tests were included. If two CRP-test results ≥2mg/L to <20mg/L were observed less than six month apart, and within two years of index, the individuals were classified to have SI. Individuals diagnosed in the first year of available eGFR were excluded to ensure only incident individuals in the study. Outcomes included costs and use of inpatient (duration ≥12h) and outpatient (<12h) hospital care, cost of primary care and prescription drugs (adjusted to 2022 currency). Results were derived using linear regression models. Results A total of 19,162 individuals’ incident between 2012-2022 were identified – 68% had SI. SI individuals had higher healthcare costs from five years before to three years after index. Individuals generated a total healthcare cost of EUR 69,554 (SI) and EUR 39,540 (no SI) in the study period (difference EUR 30,014, p<0.001). In adjusted analysis, the attributable cost in the three years following index was 1.4 times higher for individuals with SI, compared to individuals with no SI (difference EUR 12,922, p<0.001). Inpatient care accounted for 85% of the cost. SI individuals had significantly more inpatient hospital contacts from four years before to five years after index (7 attributable contacts total, 4.7 attributable contacts after index, 1.2 times more, p<0.001), and more outpatient contacts from five years before to three years after index (6.2 attributable contacts total, 2.3 attributable contacts after index, 1.3 times more, p<0.001). The largest difference was found in the year following index, where the difference was EUR 7,666 (1.5 times higher, p<0.001) cost, 1.5 (1.3 times higher, p<0.001) inpatient hospital contacts, and 1.1 (1.3 times higher, p<0.001) outpatient hospital contacts (adjusted estimates). Conclusion Individuals with SI represent a significant burden to the healthcare system, both in terms of healthcare cost and healthcare resource utilisation.Total healthcare costsAttributable hospital contacts

Taxpayers' Share of US Prescription Drug and Insulin Costs: a Cross-Sectional Study.

Drug prices affect government budgets directly through spending on public programs like Medicare and Medicaid, and indirectly via private coverage for public employees and tax subsidies for private insurance. Yet, the Senate parliamentarian ruled that the Senate could not use streamlined Budget Reconciliation to extend the Inflation Reduction Act's controls on insulin co-payment or drug prices to private insurers on the grounds that their expenditures do not affect the federal budget. To quantify insulin and other drug costs borne by federal, state, and local governments, including direct expenditures and indirect government subsidies that flow through private insurers. Cross-sectional analysis of expenditures for outpatient retail prescription drugs reported by respondents and their pharmacies in the 2019 Medical Expenditure Panel Survey (adjusted downward for drug rebates), supplemented with information on employment-related insurance from the US Office of Management and Budget and other sources. The civilian non-institutionalized US population. Direct (payments by public health insurance programs) and indirect (taxpayer-funded payments via private insurers) government expenditures for outpatient retail drugs. Direct government expenditures for outpatient retail prescription drugs totaled $154.85 billion in 2019, including $15.68 billion for insulin. Indirect government expenditures channeled through private insurers totaled $53.59 billion (including $5.48 billion for insulins). Those indirect expenditures encompassed $32.32 billion in tax subsidies for employer-sponsored private coverage, $25 million for subsidies to private Affordable Care Act marketplace plans, and $21.24 billion for government-paid premiums for public employees and retirees. Overall, government expenditures for outpatient retail prescription drugs totaled $208.44 billion, 58.76% of all-payer spending and 65.96% of spending for insulin. Governments directly or indirectly fund most drug purchases, including substantial expenditures that flow through private insurers. Hence, prices paid by private insurers impact government budgets, supporting the view that government should be allowed to regulate drug prices.

Revolutionizing Pharmacy Benefit Management: Cost-Reduction through Artificial Intelligence and Data Analytics in Healthcare

Pharmacy Benefit Managers (PBMs) are third party companies that function as intermediaries between insurance providers and pharmaceutical manufacturers. PBMs create formularies, negotiate rebates (discounts paid by a drug manufacturer to a PBM) with manufacturers, process claims, create pharmacy networks, review drug utilization, and occasionally manage mail-order specialty pharmacies. [1] Pharmacy benefit management (PBM) is important for keeping prescription drug costs under control. But the problem is that drug prices keep going up, which makes things tough for the healthcare industry. In this article, we look at how fancy technology like artificial intelligence (AI) and data analysis can help PBM find new ways to save money. By using advanced technology to study a large amount of information, PBMs can find patterns and make educated guesses about how to best use medications. Artificial intelligence makes this even more advanced by helping to quickly find and stop fraud, personalize medication plans, and predict costs more accurately. Remember this: AI and data analytics are being used to make pharmacy benefit programs work better. This helps save money and makes things better for patients. We look at how machine learning models can predict patient adherence, how natural language processing (NLP) can improve medication reviews, and how blockchain technology can keep supply chains transparent and secure. Real-world examples show how these technologies are already making a difference, such as cutting down on administrative work, reducing drug waste, and getting the most out of drug utilization. As more healthcare systems start using these advanced tools, it’s becoming clear that continual innovation and the inclusion of AI and data-driven methods are essential. This article highlights the importance of staying updated with the ever-changing ways of controlling prescription drug expenses by using new technology. For pharmacy benefit managers (PBMs) focused on offering the best value and working effectively despite increasing healthcare costs, adopting these advancements is not just a good choice, it's necessary.

Differences in Health Care Expenditures by Cancer Patients During Their Last Year of Life: A Registry-Based Study.

During the last year of life, persons with cancer should probably have similar care needs and costs, but studies suggest otherwise. A study of direct medical costs (excluding costs for expensive prescription drugs) was performed based on registry data in Stockholm County, which covers 2.4 million inhabitants, for all deceased persons with cancer during 2015-2021. The data were mainly analyzed with the aid of multiple regression models, including Generalized Linear Models (GLMs). In a population of 20,431 deceased persons with cancer, the costs increased month by month (p < 0.0001). Higher costs were mainly associated with lower age (p < 0.0001), higher risk of frailty, as measured by the Hospital Frailty Risk Scale (p < 0.0001), and having a hematological malignancy. In a separate model, where those 5% with the highest costs were identified, these variables were strengthened. Sex and socio-economic groups on an area level had little or no significance. Systemic cancer treatments during the last month of life and acute hospitals as place of death had only a moderate impact on costs in adjusted models. Higher costs are mainly related to lower age, higher frailty risk and having a hematological malignancy, and the effects are both statistically and clinically significant despite the fact that expensive drugs were not included. On the other hand, the costs were mainly comparable in regard to sex or socio-economic factors, indicating equal care.

Out-of-Pocket Prescription Drug Savings for Medicare Beneficiaries with Asthma and COPD Under the Inflation Reduction Act.

High and rising prescription drug costs for asthma and chronic obstructive pulmonary disease (COPD) contribute to medication nonadherence and poor clinical outcomes. The recently enacted Inflation Reduction Act includes provisions that will cap out-of-pocket prescription drug spending at $2,000 per year and expand low-income subsidies. However, little is known about how these provisions will impact out-of-pocket drug spending for Medicare beneficiaries with asthma and COPD. To estimate the impact of the Inflation Reduction Act's out-of-pocket spending cap and expansion of low-income subsidies on Medicare beneficiaries with obstructive lung disease. We calculated the number of Medicare beneficiaries ≥ 65years with asthma and/or COPD and out-of-pocket prescription drug spending > $2,000/year, and then estimated their median annual out-of-pocket savings under the Inflation Reduction Act's spending cap. We then estimated the number of beneficiaries with incomes > 135% and ≤ 150% of the federal poverty level who would become newly eligible for low-income subsidies under this policy. Respondents to the 2016-2019 Medical Expenditure Panel Survey (MEPS). Annual out-of-pocket prescription drug spending. An annual estimated 5.2 million Medicare beneficiaries had asthma and/or COPD. Among them, 360,160 (SE ± 38,021) experienced out-of-pocket drug spending > $2,000/year, with median out-of-pocket costs of $3,003/year (IQR $2,360-$3,941). Therefore, median savings under the Inflation Reduction Act's spending cap would be $1,003/year (IQR $360-$1,941), including $738/year and $1,137/year for beneficiaries with asthma and COPD, respectively. Total annual estimated savings would be $504 million (SE ± $42M). In addition, 232,155 (SE ± 4,624) beneficiaries would newly qualify for low-income subsidies, which will further reduce prescription drug costs. The Inflation Reduction Act will have major implications on out-of-pocket prescription drug spending for Medicare beneficiaries with obstructive lung disease resulting in half-a-billion dollars in total out-of-pocket savings per year, which could ultimately have implications on medication adherence and clinical outcomes.

Use of and spending on medical equipment among cancer survivors.

210 Background: Cancer survivors are increasingly older, with rising rates of functional impairment, comorbidity burden, and needs. Patients often require medical equipment, but administrative barriers and lack of payer coverage can limit access and increase cost sharing for patients. Prior work on financial burdens has largely focused on direct medical costs and costs of prescription drugs. We sought to characterize patterns of use and costs associated with medical equipment use among US cancer survivors. Methods: We used the US National Health Interview Survey (NHIS)—a nationally representative survey of the US population— to identify self-reported use of medical equipment (‘’such as a cane, a wheelchair, a special bed etc.’’) among cancer survivors from 1997-2018. We then used the Medical Expenditure Panel Survey (MEPS) — which includes additional data on health care costs and spending among people sampled from the NHIS— to evaluate out-of-pocket (OOP) and total spending on equipment (e.g., orthopedic items, prosthesis, bathroom aids, disposable supplies etc.) among cancer survivors from 2016-2020. We describe trends in prevalence of use, and compared OOP costs and percentage of cost sharing responsibility (OOP cost/total spending) for equipment relative to other medical care, such as prescription drugs. Results: We identified 55,625 cancer survivors in the NHIS, representing 19.1 million weighted individuals from 1997-2018. The weighted number of cancer survivors using medical equipment increased during the study period from 0.9 million in 1997 to 2.3 million 2018, a 2.4-fold increase. The number of survivors not requiring equipment increased by 1.7-fold during the same period. The adjusted prevalence of equipment use among survivors increased from 5.1% in 1999 to 7.9% in 2018, a 2.8 percentage-point increase (P &lt; .001 for trend). We identified 32,106 cancer survivors (56.6% women, 55.9% ≥65 years) in MEPS from 2016-2020. Among users, mean annual total spending on equipment was 1,205, and mean OOP costs for equipment were 672. For comparison, mean annual OOP costs for prescription drugs was $541. The cost sharing responsibility for equipment (56%) was higher than that for all other comparison groups: prescription drugs (10%), outpatient visits (11%), occupational/physical therapy (18%), emergency room visits (20%), and hospitalization (3%). Conclusions: The number of US cancer survivors who use medical equipment has more than doubled during the past 20 years. For these patients, OOP costs for equipment are greater than that for prescription drugs, with patients responsible for over half the total spending. These data are particularly notable given that patterns of use and spending reported here do not capture survivors unable to access necessary equipment due to administrative, financial, and/or other barriers. Interventions to assess need, ensure access, and decrease associated financial burden are urgently needed.

Bariatric surgery decreases prescription drug costs for metabolic syndrome: a Canadian population-based cohort study.

Obesity is a chronic disease that is significantly linked to metabolic syndrome. Bariatric surgery is considered the most effective treatment for obesity resulting in long-term weight loss and comorbidity resolution. Prior studies have demonstrated the overall cost effectiveness of bariatric surgery; however, there is little data regarding direct pharmaceutical costs. The objective of this population-based study is to compare the cost of dispensed common prescription medications for metabolic syndrome before and after bariatric surgery. All patients that were enrolled in the Center for Metabolic and Bariatric Surgery who underwent gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Basic demographic information and outpatient prescription dispensation data were obtained from the Manitoba Population Research Data Repository, which is housed at the Manitoba Centre for Health Policy. Specific drug categories that were reviewed for costs 5years before and after surgery included Antihypertensives, Lipid Lowering Agents, Insulin and Non-insulin Diabetic Drugs. One thousand one hundred and eighty four patients were included in this review. Comparing the 5-yearpre- and post-surgery, there was a decrease in the overall amount of drug dispensed and the overall cost for all drug categories in the 5years following surgery. These categories included Antihypertensives ($506,268.8), Lipid Lowering Agents ($173,866.48), Insulin ($549,305.92), and Other Diabetes Drugs ($513,371.1). Additionally, older patients experienced a larger proportion of cost savings compared to younger patients, with the exception of non-insulin diabetic medications which trended to have more cost savings in the 30-49year old grouping. This is the first Canadian study to use accurate dispensing data from a provincial administrative prescription database to capture long-term cost savings for metabolic prescriptions after bariatric surgery. The results are consistent with the existing literature for prescriptions post-bariatric surgery. Future study will include subgroup analysis by patient age, gender, income quintile, and geography.

Pharmacy benefit managers and drug affordability policy proposals for enhancing access in underserved communities

Pharmacy Benefit Managers (PBMs) play a pivotal role in the pharmaceutical supply chain, yet their practices have increasingly contributed to the rising costs of prescription drugs and limited access to essential medications, particularly in underserved communities. This paper critically examines the role of PBMs, highlighting their challenges to drug affordability and accessibility. It explores the limitations of existing policies and proposes comprehensive reforms to enhance transparency, accountability, and fairness in PBM operations. The proposed policy interventions include mandatory transparency in PBM rebates and formularies, regulations on rebate retention, and fair reimbursement rates for pharmacies. Additionally, broader strategies such as government regulation of drug prices, expanded subsidies for low-income populations, and value-based contracts are discussed as potential solutions. The paper concludes with recommendations for policymakers, healthcare providers, and PBMs, emphasizing the need for collaborative efforts to ensure the successful implementation of these reforms. Addressing the issues posed by current PBM practices, these policy proposals aim to significantly improve drug affordability and access in underserved communities, ultimately contributing to a more equitable healthcare system. Keywords: Pharmacy Benefit Managers (PBMs), Drug Affordability, Healthcare Access, Underserved Communities, Policy Reform, Pharmaceutical Supply Chain.

An assessment of the implications of distribution remuneration and taxation policies on the final prices of prescription medicines: evidence from 35 countries

AbstractThis paper analyses the structure of and variability in taxation and prescription drug distribution policies and quantifies the impact of such policies on the cost of prescription drugs to health systems in 35 countries. Taxes on prescription drugs remain highly prevalent (83% of the sample) although 63% of the sample countries implement a lower than standard VAT rate. Three remuneration types of the wholesale and retail distribution chain have been identified. Wholesale and retail distributors are remunerated on a regressive mark-up basis, which is price-dependent, although fixed fees and fixed percentages, which are non-price dependent, are also highly prevalent. Price component analysis for three groups of products classed as high-, medium- and low-priced suggests that mark-ups plus taxes varied significantly across countries and products, and ranged from 5% to 187% of ex-factory prices. Average margins also vary significantly by countries and products ranging 5–65% of retail prices. The cost of distribution and taxation contributes significantly to prescription drug costs for health systems. Although distribution chain remuneration raises efficiency and overall affordability questions, these need to be considered together with the regulatory framework shaping market structure of the distribution chain, as well as any prevailing horizontal and vertical integration policies. The overall cost of prescription drugs could be reduced immediately by eliminating taxation; this could go some way to alleviate fiscal pressures on health budgets, whilst avoiding resource re-allocation from health to other sectors.

Prescription Drug Costs Among People With Alzheimer Disease and Related Dementias

Prescription Drug Costs Among People With Alzheimer Disease and Related Dementias

Patient Assistance Programs—A New Era of Law and Policy

This Viewpoint from authors at PORTAL discusses the importance of patient assistance programs in covering the cost of prescription drugs, highlights 2 recent rulings that illustrate the substantial barriers to regulating these programs, and calls for continued evaluation of these programs’ effectiveness and costs.

Comparing Quality, Costs, and Outcomes of VA and Community Primary Care for Patients with Diabetes.

The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded access to independent community providers outside the Veterans Health Administration (VA). Little is known how quality, costs, and outcomes of primary care received in the community compare to that of the VA. To compare quality, costs, and outcomes of community and VA-provided primary care for patients with diabetes over a 12-month episode. A cross-sectional study using VA administrative data and community care claims. Adjusted analyses were conducted using inverse probability weighted regression adjustment to balance patient characteristics. Veterans with diabetes receiving primary care in the VA or community. Quality measures included receipt of hemoglobin A1C tests, eye exams, microalbumin urine tests, and flu shots. Outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC). Costs were measured for VA and community outpatient care, inpatient care, and prescription drugs. There were 652,648 VA patients and 3650 community care patients. VA patients were less likely to be White, had shorter mean drive time to VA primary care, and were less likely to be rural than community care patients. In adjusted analyses, community care patients had significantly lower probability of receiving a hemoglobin A1C test, eye exam, microalbumin urine test, and flu shot compared to the VA group. There was no difference in probability of an ACSC hospitalization. Community care patients had higher mean total costs ($1741 [95% CI, $431, $3052]), driven by higher inpatient and prescription drug costs but lower emergency care costs than VA patients. Patients receiving community primary care had worse diabetes quality and higher costs than patients receiving VA primary care. There was no difference in health outcomes. Care provided by an integrated delivery system may have advantages in quality and value.

Computational aspects of DFT, HOMO-LUMO, PED, molecular docking and basic characterisations of Octadec-9-Enoic Acid (C18H34O2)

Finding a few potential ‘green’ inhibitors has been a long-term goal because these products that are derived from plants enable prescription drug costs reduced, side effects minimised and biodegradable. Known by its common name, Hybanthusenneaspermus (L.) F. Muell, which is a member of the Violaceae family, is a herb or shrub found worldwide in tropical and subtropical climates. Knowing the applicability of H. enneaspermus for the treatment of a variety of acute or chronic diseases with a diverse nature of phytoconstituents will be made easier with the information provided in this comprehensive article. The majority of the information in this research article was gathered from different scientific sources that focused on H. enneaspermus research. Plant extraction, optimised geometry, thorough vibrational assignment, and characterisation of the fundamental vibrational modes of Octadec-9-Enoic Acid were conducted using experimental FT-IR and UV-Vis data in addition to quantum chemistry research. The actual vibrational data were compared to the wavenumbers computed theoretically for the chemical's optimal shape using DFT/B3LYP gradient calculations with the 6-311G ++ (d,p) basis set. A computation has been performed utilising the energy gap between HOMO and LUMO. Intramolecular interactions (NBO), molecular electrostatic potential (MEP) at a specific point p (x,y,z), atomic charge values, NMR & UV-vis computation, and molecular docking studies with protein-ligand interactions were all interpreted using natural bond orbital analysis.

Real-world comparison of health care costs of venetoclax-obinutuzumab vs Bruton's tyrosine kinase inhibitor use among US Medicare beneficiaries with chronic lymphocytic leukemia in the frontline setting.

Bruton's tyrosine kinase inhibitors (BTKis) and the BCL-2 inhibitor venetoclax in combination with obinutuzumab (VEN-O) are both recommended as frontline therapy in chronic lymphocytic leukemia (CLL). However, VEN-O is a 12-month fixed-duration therapy generating durable remissions whereas BTKis are continuous treat-to-progression treatments. To examine costs before and after the fixed-duration treatment period for VEN-O relative to that observed for BTKis in a national sample of older US adults with CLL in the frontline setting. This retrospective analysis used Medicare Parts A, B, and D claims from 2016 to 2021. Fee-for-service Medicare beneficiaries aged 66 years or older initiating frontline CLL treatment with VEN-O or a BTKi treatment between June 1, 2019, and June 30, 2020 (index date = first prescription fill date), were included in the sample. Mean cost measures were captured for both groups over 2 fixed time periods calculated from the index date: Month 0 to 12 (proxy for VEN-O on-treatment period) and Month 13 to 18 (proxy for VEN-O off-treatment period). A difference-in-difference approach was used. Multivariate generalized linear models estimated changes in adjusted mean monthly costs during Month 0 to 12 vs Month 13 to 18, for the VEN-O group relative to the BTKi group. The final sample contained 193 beneficiaries treated with VEN-O and 1,577 beneficiaries treated with BTKis. Risk-adjusted all-cause monthly total costs were similar for VEN-O patients ($13,887) and BTKi patients ($14,492) between Month 0 and 12. Moreover, during Month 13 to 18, the mean monthly all-cause total costs declined by 67% for VEN-O ($13,887 to $4,462) but only by 10% for BTKi ($14,492 to $13,051). Hence, the relative reduction in costs across the 2 periods was significantly larger for VEN-O (-$9,425) vs BTKi (-$1,441) patients (ie, difference in difference = -$7,984; P < 0.001). Similar patterns were observed for CLL-related costs, with the substantially larger reductions in CLL-related total monthly costs (-$9,880 VEN-O vs -$1,753 BTKi; P < 0.001) for the VEN-O group primarily driven by the larger reduction in CLL-related monthly prescription costs (-$9,437 VEN-O vs -$2,020 BTKi; P < 0.001). This real-world study of older adults with CLL found a large reduction in monthly Medicare costs in the 6 months after completion of the fixed-duration treatment period of VEN-O, largely driven by the reduction in CLL-related prescription drug costs. A similar decline in costs was not observed among those treated with BTKis. Our study highlights the substantial economic benefits of fixed-duration VEN-O relative to treat-to-progression therapies like BTKis in the first-line CLL setting.

Trends in direct health care costs among US adults with atherosclerotic cardiovascular disease with and without diabetes

ObjectivePopulation-based national data on the trends in expenditures related to coexisting atherosclerotic cardiovascular diseases (ASCVD) and diabetes is scarce. We assessed the trends in direct health care expenditures for ASCVD among individuals with and without diabetes, which can help to better define the burden of the co-occurrence of diabetes and ASCVD.MethodsWe used 12-year data (2008–2019) from the US national Medical Expenditure Panel Survey including 28,144 U.S individuals aged ≥ 18 years. Using a two-part model (adjusting for demographics, comorbidities and time), we estimated mean and adjusted incremental medical expenditures by diabetes status among individuals with ASCVD. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).ResultsThe total direct expenditures for individuals with ASCVD increased continuously by 30% from $14,713 (95% confidence interval (CI): $13,808–$15,619) in 2008–2009 to $19,145 (95% CI: $17,988–$20,301) in 2008–2019. Individuals with diabetes had a 1.5-fold higher mean expenditure that those without diabetes. A key driver of the observed increase in direct costs was prescription drug costs, which increased by 37% among all individuals with ASCVD. The increase in prescription drug costs was more pronounced among individuals with ASCVD and diabetes, in whom a 45% increase in costs was observed, from $5184 (95% CI: $4721–$5646) in 2008–2009 to $7501 (95% CI: $6678–$8325) in 2018–2019. Individuals with ASCVD and diabetes had $5563 (95% CI: $4643–$6483) higher direct incremental expenditures compared with those without diabetes, after adjusting for demographics and comorbidities. Among US adults with ASCVD, the estimated adjusted total direct excess medical expenditures were $42 billion per year among those with diabetes vs. those without diabetes.ConclusionsIn the setting of ASCVD, diabetes is associated with significantly increased health care costs, an increase that was driven by marked increase in medication costs.

An analysis of the impact on total cost of care within a pharmacist‐led comprehensive medication management program

AbstractIntroductionThe rise in health care expenditures continues to pose a significant concern regarding the longevity of the current health care system design. The literature has demonstrated a positive return on investment (ROI) when pharmacists perform medication management services. Building upon positive ROI literature, a clinically integrated network (CIN) in Michigan developed an approach to patient targeting for comprehensive medication management (CMM) services in existing alternative payment model (APM) Medicare Advantage, Medicaid, and Commercial contracts.ObjectivesThe primary objective of this study was to examine the real‐world impact of an advanced ambulatory care pharmacy model, inclusive of embedded clinic‐based ambulatory pharmacists, centralized ambulatory pharmacists, centralized population health pharmacists, and specially trained pharmacy technicians, on the total cost of care (TCOC) within a large integrated health system.MethodsFor CMM dates of service occurring in calendar year 2022, pharmacy and medical claims were evaluated during the 6‐month period prior to and following the initial CMM patient encounter. Upon completion of the study period, data were evaluated to assess TCOC and utilization trends for the study population.ResultsStatistically significant differences in median TCOC ($1427.84, p &lt; 0.001), prescription drug costs ($222.82, p &lt; 0.001), and medical costs ($462.26, p &lt; 0.001) were observed between the pre‐CMM and post‐CMM timeframes for the study population. A 16% reduction in hospital admissions was observed between the pre‐CMM and post‐CMM timeframes.DiscussionThis study further supports that pharmacist intervention as part of a CMM program can favorably affect health care costs. Criteria such as a population's benchmark costs and utilization, insurance product types, and core conditions present can help determine whether expanding or initiating CMM services could be beneficial in improving care and health care costs.

Aging populations and expenditures on health

Aging populations exert upwards pressure on healthcare systems, raising concerns about increasing expenditures on health. This paper reviews the empirical literature on the issue and critically assesses the strengths and weaknesses of the outcomes measured, methodologies used, and the hypotheses tested. While age strongly predicts long-term care expenditure, the time-to-death factor renders the aging effect null for hospital care expenditure. Existing literature disagrees on the importance of age and time-to-death effects on prescription drug and ambulatory care costs. Morbidity and medical innovation mediate these effects, proving crucial for aging-related healthcare expenditure growth. We identify several opportunities for future research including gender differences, utilization of emerging methods, and the importance of institutional settings.

Oncology drug pricing: potential Medicare savings on cancer-directed and supportive care medications through the Mark Cuban cost plus drug model.

Prescription drug costs within oncology remain a challenge for many patients with cancer. The Mark Cuban Cost Plus Drug Company (MCCPDC) launched in 2022, aiming to provide transparently priced medications at reduced costs. In this study, we sought to describe the potential impact of MCCPDC on Medicare Part-D oncology spending related to cancer-directed (n = 7) and supportive care (n = 26) drugs. We extracted data for drug-specific Part-D claims and spending for 2021. Using 90-count purchases from MCCPDC, we found potential Part-D savings of $857.8 million (91% savings) across the 7 cancer-directed drugs and $28.7 million (67% savings) across 21/26 (5/26 did not demonstrate savings) supportive care drugs. Collectively, our findings support that alternative purchasing models like MCCPDC may promote substantial health care savings.

Association of Opioid and Concurrent Benzodiazepine, Skeletal Muscle Relaxant, and Gabapentinoid Usage on Healthcare Expenditure and Resource Utilization: A Serial Cross-Sectional Study, 2009 to 2019.

Healthcare providers may be utilizing central nervous system (CNS) depressants to reduce opioid use due to recent changes in public policy. Combination use of these agents with opioids increases the risk of respiratory depression and death. Healthcare expenditures by individuals using these drug combinations have not been previously quantified. We sought to characterize healthcare costs and expenditures associated with a population reporting concurrent CNS depressants and opioid use compared with nonopioid analgesics in the United States from 2009 to 2019. A serial cross-sectional design was used to compare the healthcare expenditures of adult Medical Expenditure Panel Survey respondents who were prescribed nonopioid analgesics, opioids only, opioids/benzodiazepines (BZD), opioids/BZD/skeletal muscle relaxants (SMR), or opioids/gabapentin (gaba) using pooled data from 2009 to 2019. Expenditure (cost and resource utilization) categories included inpatient, outpatient, office-based, and prescription medicine. Average marginal effects were used to compare survey-weighted annual costs and resource utilizations across the groups as compared to nonopioid analgesic respondents, adjusted for covariates. A weighted total of 34 241 838 individuals were identified. Most were opioid-only respondents (46.5%), followed by nonopioid analgesic (43.4%), opioid/BZD (5.3%), opioid-gaba (3.5%), and opioid/BZD/SMR respondents (1.3%). In comparison to the study groups with nonopioid analgesics, opioid-gaba users had the highest significant incremental cost difference among the different pairings (+$11 684, P < .001). Opioid-gaba, opioid/BZD, and opioid/BZD/SMR respondents had significantly higher inpatient, emergency department, and prescription drug costs and use compared to nonopioid analgesic respondents. Opioid-only respondents had higher outpatient and office-based costs and visits compared to nonopioid analgesic respondents. As healthcare providers seek to utilize fewer opioids for pain management, attention must be paid to ensuring safe and effective use of concurrent CNS depressants to mitigate high healthcare costs and burden.