Prescription Drug Costs Research Articles

Impact of Real-Time Benefit Tools on Patients’ Access to Medications: A Retrospective Cohort Study

High out-of-pocket prescription drug costs can lead to patient nonadherence and poor health outcomes.1-6 One component of this problem stems from our complex system of prescription drug pricing; medical providers do not know the cost of the medications they are prescribing.7 Accordingly, clinicians may unwittingly order expensive medications that their patients struggle to afford. When faced with such prices, patients may decline to pick up medications from their pharmacies. For some, this may result in a delay in care as prescribers attempt to identify and prescribe affordable alternatives.

Industry Payments to Physicians Are Kickbacks. How Should Stakeholders Respond?

Payments from the pharmaceutical industry to US physicians are common. In determining which payments rise to the level of an illegal kickback under the Anti-Kickback Statute (AKS), the Department of Health and Human Services' Office of Inspector General (OIG) has stated in nonbinding guidance that influencing or "swaying" physician prescribing is key. OIG has highlighted as a compliance standard the Pharmaceutical Research and Manufacturers of America Code on Interactions with Health Professions, which stipulates that permissible payments are those that do not interfere with prescribing. However, recent evidence has shown that most payments influence physician prescribing, driving higher prescription drug costs by increasing use of brand-name and low-value drugs. This evidence implies that many payments that are currently commonplace could be subject to prosecution under AKS. Given that these payments increase costs to patients and the health care system, there is a public interest in curtailing them. This article proposes a range of actions available to stakeholders-including industry, providers, regulators, and payers-to mitigate the cost-increasing effect of industry payments to physicians.

Healthcare costs and resource utilization associated with renal cell carcinoma among older Americans: A longitudinal case-control study using the SEER-Medicare data.

To determine 1-year and 5-year total healthcare costs and healthcare resource (HRU) associated with renal cell carcinoma (RCC) in older Americans, from a healthcare sector perspective. This was a longitudinal, retrospective cohort study using the Surveillance, Epidemiology and End Results-Medicare linked data (2006-2014), which included older (≥66 years) patients with primary RCC and 1:5 matched noncancer controls. Patients/controls were followed from diagnosis (pseudo-diagnosis for controls) until death or up to loss-to-follow-up (censored). Per-patient average 1-year and 5-year cumulative total and incremental total healthcare costs and HRU were reported. A total of 11,228 RCC patients were matched to 56,140 controls. Per-patient cumulative average 1-year (incremental = $38,291 [$36,417-$40,165]; $57,588 vs. $19,297) and 5-year (incremental = $68,004 [$55,123-$80,885]; $183,550 vs. $115,547) total costs (excluding prescription drug costs) were 3 and 1.6 times higher for RCC vs. controls. These estimates were 3.6 and 1.7 times higher for RCC vs. controls when prescription costs were included in total costs. Prescription drug costs accounted for 8.4% (incremental = $3,715) and 18.1% (incremental = $15,375) of the 1-year and 5-year incremental total costs, respectively. RCC patients had greater cumulative number of hospitalizations, emergency department visits and prescriptions in 1- and 5-years, compared to controls. Average first year total cost for a patient with incident diagnosis of RCC is substantially higher than that for controls and it varies depending on the stage at diagnosis. Study findings could help in planning future resource allocation and in determining research and unmet needs in this patient population.

Expected Cost Savings From Low-Dose Computed Tomography Scan Screening for Lung Cancer in Alberta, Canada

IntroductionThe expensive modern therapeutic regimens for advanced lung cancer (LC) stages have been recently approved. We evaluated whether low-dose computed tomography (LDCT) LC screening of high-risk Albertans is cost saving. MethodsWe used a decision analytical modeling technique with a health system perspective and a time horizon of 3 years to compare benefits associated with reduced health service utilization (HSU) from earlier diagnosis to the costs of screening. Using patient-level data, HSU costs by stage of disease were estimated for patients with LC, including inpatient, outpatient, and physician services, and costs for prescription drugs and cancer treatments. ResultsOf 101,000 people aged 55 to 74 years eligible for screening, an estimated 88,476 scans would be performed in Alberta in 3 years. Given LDCT sensitivity and specificity of 90.5% and 93.1%, respectively, we estimated that a stage shift toward earlier diagnosis would be expected whereby 43% more patients would be identified at stage 1 or 2 as compared with without screening. The estimated cost of screening is $35.6 million (M), whereas the stage shift associated with screening would avoid $42M in HSU costs. The net cost avoidance associated with screening is therefore $6.65M. The probability for the screening to be cost saving is estimated at 72%. ConclusionsThis study has revealed that LDCT LC screening is likely to be cost saving in Alberta. Adoption of this program into the provincial health care system is worth considering provided constraints in the system related to surgical capacity and CT wait times could be addressed.

MO187: Healthcare Costs based on Risk of Progression in Patients with Chronic Kidney Disease

Abstract BACKGROUND AND AIMS Nephrologists follow patients with chronic kidney disease (CKD) stage G3 and G4 as a homogeneous group with the assumption that everyone had similar rates of progression with scheduled visits and lab investigations based on the stage of the disease. We now recognize that not all patients progress at similar rates to kidney failure and treatment and follow-up needs vary. The Kidney Failure Risk Equation (KFRE) identifies patients at different risks of progression to kidney failure (low, medium and high risk) in each stage of the disease. Previous studies had looked at resource utilization of patients based on the stage of the CKD. The purpose of our analysis was to examine resource utilization and associated costs based on the risk of progression by KFRE in the setting of a universal healthcare system. METHOD We conducted a retrospective cohort study of adults with CKD G3 and G4 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data was collected from January 2004 through December 2012 and patients were followed for 5 years. The predicted risk of kidney failure for each patient was calculated using the 8-variable KFRE. The equation used clinical and routine laboratory data, to stratify patients into three risk categories (low, medium and high risk) of progression. We compared the number and cost of hospital admissions, physician visits and prescription drugs by risk within G3 and G4. Negative binomial regression and generalized linear model were used to compare healthcare utilization and cost between the groups respectively (α = 0.05). RESULTS A total of 1003 adults with CKD G3 and G4 were included in the study. In patients with stage G3 CKD, 311 (59%), 150 (28%) and 68 (13%) were in low, medium and high-risk categories, respectively. Amongst patients with CKD stage G4, 275 (58%), 86 (18%) and 113 (24%) were in similar categories respectively. The cost of hospital admissions, physician visits and drug dispensations in stage G4 high risk in comparison to low risk over the 5-year study period was CAD $89 265 versus $48 374 (P = .008), $23 423 versus $11 231 (P < .001) and $21 853 versus $16 757 (P = .01), respectively. In stage G3, the cost of hospital admissions was CAD $55 944 versus $36 740 (P = 0.10), physician visits $13 414 versus $10 370 (P = .08) and prescription drugs $20 394 versus $14 902 (P = .02) in high-risk patients in comparison to low-risk patients (Figure 1). CONCLUSION In patients followed in multidisciplinary clinics with CKD stages G3 and G4, the cost of hospital admissions, physician visits and prescription drugs were higher in high-risk patients compared to patients in low-risk category. In our study, the KFRE, designed to predict the risk of progression to dialysis in patients with CKD, also assisted in identifying patients with higher health resource utilization and healthcare costs compared to those with lower health resource use. We additionally suggest that patients who are in medium and high-risk categories be followed in multidisciplinary clinics rather than individual physician offices to delay the trajectory of decline to kidney failure.

MP39-02 LONG TERM COST COMPARISONS OF RADICAL CYSTECTOMY VERSUS TRIMODAL THERAPY FOR MUSCLE-INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 May 2022MP39-02 LONG TERM COST COMPARISONS OF RADICAL CYSTECTOMY VERSUS TRIMODAL THERAPY FOR MUSCLE-INVASIVE BLADDER CANCER Vishnukamal Golla, Yong Shan, Elias Farran, Courtney Stewart, Kevin Vu, Alexander Yu, Ali Raza Khaki, Kirk Keegan, Ashish Kamat, Douglas S. Tyler, Stephen J. Freedland, and Stephen B. Williams Vishnukamal GollaVishnukamal Golla More articles by this author , Yong ShanYong Shan More articles by this author , Elias FarranElias Farran More articles by this author , Courtney StewartCourtney Stewart More articles by this author , Kevin VuKevin Vu More articles by this author , Alexander YuAlexander Yu More articles by this author , Ali Raza KhakiAli Raza Khaki More articles by this author , Kirk KeeganKirk Keegan More articles by this author , Ashish KamatAshish Kamat More articles by this author , Douglas S. TylerDouglas S. Tyler More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , and Stephen B. WilliamsStephen B. Williams More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002599.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Earlier studies on the cost of muscle-invasive bladder cancer treatments are limited to short-term periods of cost. Our study objective is to compare the 2- and 5-year costs associated with trimodal therapy (TMT) versus radical cystectomy (RC) benchmarked against costs for patients who received no curative treatment. METHODS: This cohort study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Medicare expenditures were summed from inpatient, outpatient, and physician services within 2 and 5 years of diagnosis to determine total costs Total Medicare costs at 2-and 5-years following TMT versus RC were compared using inverse probability of treatment-weighted (IPTW) propensity score models. RESULTS: A total of 2,537 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 through December 31, 2009. Total median costs for patients that received no definitive/systemic treatments (RC, TMT, radiotherapy alone, or chemotherapy alone) were $73,780 vs. $88,275 at 2-and 5-years respectively. Total median costs were significantly higher for TMT than RC at 2-years ($372,839 vs. $191,363, p<0.001) and 5-years ($424,570 vs. $253,651, p<0.001), respectively. TMT had higher outpatient median costs than RC (2-yr: $318,221 vs. $100,900; 5-yr: $367,092 vs. $146,561) with significantly higher costs largely associated with radiology, medications, pathology/laboratory, and other professional services. Out-of-pocket prescription drug costs within 5 years of diagnosis were not significantly different for RC vs. TMT (median, $732 vs. $822; H-L Median, $-17; 95% CI, -$213 to $178). CONCLUSIONS: TMT vs. RC was associated with higher long-term costs among patients with muscle-invasive bladder cancer largely driven by outpatient expenditures. Reduction in costs associated with radiology, medications, pathology/laboratory, and other professional services may improve the value of TMT. Source of Funding: DOD PRCRP CDA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e664 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vishnukamal Golla More articles by this author Yong Shan More articles by this author Elias Farran More articles by this author Courtney Stewart More articles by this author Kevin Vu More articles by this author Alexander Yu More articles by this author Ali Raza Khaki More articles by this author Kirk Keegan More articles by this author Ashish Kamat More articles by this author Douglas S. Tyler More articles by this author Stephen J. Freedland More articles by this author Stephen B. Williams More articles by this author Expand All Advertisement PDF DownloadLoading ...

Rejuvenating American Healthcare

The debate over overhauling the American healthcare system is stuck on hold and plagued by soundbites. It’s time to insert substance and science into the conversation. If we learn nothing else from the COVID-19 experience, it’s that when the entire healthcare ecosystem works together to solve a seemingly unsolvable problem (in this case broader access to innovative prescription drugs) … we can. Nothing less than the future of American healthcare is at stake. During his March 2022 State of the Union Address, President Biden suggested a policy of price controls through direct Medicare negotiation to lower the costs of prescription drugs. This approach has long been discussed in the abstract. Let’s examine the details and potential consequences of such a proposition more closely.&#x0D; &#x0D; &#x0D;

Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.

The objective is to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. The LIS reduces out-of-pocket drug costs for low-income beneficiaries; however, not all LIS-eligible individuals are enrolled. Take-up of the LIS, and consequences of forgoing this benefit among beneficiaries with diabetes, remains unknown. Health and Retirement Study linked to Medicare administrative data from 2008 to 2016. We conducted two analyses among beneficiaries with diabetes. First, we estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), we conducted propensity score-weighted regression analyses to compare out-of-pocket costs, the prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. N/A. Among Medicare beneficiaries with diabetes, 68.1% of those with incomes >100% to ≤150% of FPL received the LIS, while 90.3% with incomes ≤100% of FPL received the LIS. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518; 95 [in USD]% CI: $370 [in USD], $667 [in USD]; p < 0.001), filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs (95% CI: -11.1, -3.5; p < 0.001), and were 8.9 percentage points more likely to report skipping drugs due to cost (95% CI: 0.3, 18.0; p=0.04), all compared to LIS enrollees. Despite providing substantial financial assistance with prescription drug costs, the LIS is under-utilized among beneficiaries with chronic conditions requiring routine medication use. As policy makers discuss Part D reforms to address rising out-of-pocket drug costs, they should consider strategies to increase participation in existing programs that alleviate cost burdens among low-income Medicare beneficiaries.

Pediatric Concurrent Hospice Care: Cost Implications of a Hybrid Payment Model.

Implementation of concurrent hospice care led to a new hybrid payment model that combines hospice payments with payments for non-hospice medical care. Little is known about the cost implications of this new hybrid payment model. The purpose was to identify costs and compare concurrent care and standard hospice care costs by estimating the average incremental Medicaid cost of care over time. Using national Medicaid data of 18147 hospice children and a multilevel generalized linear model, we calculated the incremental costs of receiving concurrent vs standard hospice care. We used the total cost of care over the last year of life. Increments for the analysis were hospice length of stay, stratified to 1 day, 2-14 days, and 15 + days. Overall, compared to standard hospice care, enrollment in concurrent hospice care was significantly associated with an increase in outpatient care and prescription drug costs. For a stay of 1 day, concurrent hospice care decreased inpatient costs and increased costs of prescription drugs. For stays between 2 and 14 days, concurrent hospice decreased total costs and inpatient costs, but increased prescription drug costs. With a hospice stay of 15 + days, concurrent hospice had significantly higher costs across all measures, including total costs, inpatient costs, outpatient costs, and prescription drug costs. This study provides critical insight into incremental costs of receiving concurrent vs standard hospice care. More research is needed to understand how concurrent hospice lengthy hospice stays are associated with increases of costs.

The Economic Burden of Multiple Sclerosis in the United States: Estimate of Direct and Indirect Costs.

Background and ObjectivesA recent report estimated that approximately 1 million adults were living with multiple sclerosis (MS) in the United States. Although MS is rarely the direct cause of death, its debilitating effects on normal body functions can result in considerable disruption to daily living and life roles including work, physical independence, mobility, social interaction, and participation in leisure activities. This study estimated the total economic burden of MS in the United States in 2019.MethodsThis study used a prevalence-based approach to estimate the national economic burden of MS. Claims from 3 sources (Medicare Current Beneficiary Survey, Medicare Standard Analytical File, and Optum de-identified Normative Health Information System) were used to obtain direct costs and a survey was developed to collect indirect costs (e.g., labor market productivity losses, costs of paid and unpaid caregivers, home modification) from 946 patients with MS (PwMS). Direct medical costs reflected the difference in the total average annual amount paid for PwMS vs matched controls without MS. Future earnings loss due to premature death attributable to MS was calculated using Centers for Disease Control and Prevention mortality data and Medicare claims data.ResultsThe estimated total economic burden was $85.4 billion, with a direct medical cost of $63.3 billion and indirect and nonmedical costs of $22.1 billion. Retail prescription medication (54%); clinic-administered drugs, medication, and administration (12%); and outpatient care (9%) were the 3 largest components of the direct costs. The average excess per-person annual medical costs for PwMS was $65,612; at $35,154 per person, disease-modifying therapies (DMTs) accounted for the largest proportion of this cost. The cost per DMT user ranged from $57,202 to $92,719, depending on sex–age strata. The average indirect and nonmedical costs were $18,542 per PwMS and $22,875 per PwMS if caregivers' costs were included. Lost earnings due to premature death, presenteeism, and absenteeism losses were the largest indirect cost components.DiscussionMS is a costly chronic disease, with direct costs of prescription drugs and indirect productivity loss being important cost drivers. Our findings suggested that the burden of MS in the United States has been underestimated.

Trends and determinants of retail prescription drug costs.

To characterize price trends and variation for US generic and branded drugs at the retail level as they relate to pharmacy acquisition costs and local market factors. Drug pricing data consisting of US pharmacy claims from 2014 to 2019 collected and licensed by GoodRx, an online tool for comparing drug prices. Time trends of median drug prices and coefficients of variation were measured for generic and branded drugs, including subgroups based on clinical condition (i.e., diabetes and cancer). Pharmacy competition was measured using the Herfindahl-Hirschman Index (HHI) at the zip-code level. Multivariable linear regression analysis assessed the impact of local market-level factors on drug prices and variation. US drug pricing data consisting of claims filled through a mix of public and private insurance at 58,332 chain and independent pharmacies across 14,421 zip codes in all 50 states. From 2014 to 2019, pharmacy retail markets trended towards greater competition: average HHI by zip code decreased by 15.0% (p < 0.001). Median cash price increased significantly for both generic (6.58%, p < 0.001) and branded (84.10%, p < 0.001) drugs. When normalized to acquisition costs, cash prices for generic drugs rose 22.03% (p < 0.001) while those of branded drugs decreased by 2.31% (p < 0.001). Diabetes drugs showed higher baseline overall markup of cash prices relative to acquisition costs (10.54, Interquartile range (IQR) 3.28-18.43) than cancer drugs (1.88, IQR 1.36-3.08). Neither local pharmacy competition nor median income significantly predicted drug price or variation. Measures of generic drug price and price variation are high despite decreased costs earlier in the pharmaceutical supply chain, defying expectations of what would happen in a competitive market. Efforts to bypass the pharmacy benefit model for generic drugs may offer consumers an opportunity for substantial savings.

Health care system and patient costs associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults

BackgroundDepression and anxiety disorders in older adults are associated with a great burden. Research has shown that less than 50% of adults receive adequate treatment in primary care settings for these disorders. Rare are the studies however assessing adequate treatment in older adults and associated costs from the societal perspective. Given the episodic nature of common mental disorders, this study aims to assess the three-year costs from a restricted societal perspective (including health system and patient perspectives) associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults consulting in primary care.MethodsThis primary care cohort study included 358 older adults aged 65 years and older with either a self-reported or physician diagnosis of depression or an anxiety disorder covered under Quebec’s public drug plan. Receipt of minimally adequate treatment was assessed according to Canadian guidelines and relevant reports. Outpatient and inpatient service use, medication costs and physician billing fees were obtained from provincial administrative databases. Unit costs were calculated using provincial financial and activity reports and relevant literature. A propensity score was created to estimate the probability of receiving minimally adequate treatment and the inverse probability was used as a weight in analyses. Generalized linear models, with gamma distribution and log link, were conducted to assess the association between receipt of minimally adequate treatment and costs.ResultsOverall, receipt of minimally adequate treatment was associated with increased three-year costs averaging $5752, $536, $6266 for the health system, patient and societal perspectives, respectively, compared to those not receiving minimally adequate treatment. From the health system perspective, participants receiving minimally adequate treatment had higher costs related to emergency department (ED) (difference: $457, p = 0.001) and outpatient visits (difference: $620, p < 0.001), inpatient stays (difference: $2564, p = 0.025), drug prescriptions (difference: $1243, p = 0.002) and physician fees (difference: $1224, p < 0.001). From the patient perspective, receipt of minimally adequate treatment was associated with higher costs related to loss of productivity related to ED (difference: $213, p < 0.001) and outpatient visits (difference: $89, p < 0.001).ConclusionsOlder adults receiving minimally adequate treatment for depression and anxiety disorders incurred higher societal costs reaching $2089 annually compared to older adults not receiving minimally adequate treatment. The main cost drivers were attributable to hospitalizations and prescription drug costs.

Clinical and economic impact of primary hyperoxaluria: a retrospective claims analysis.

BACKGROUND: Primary hyperoxaluria (PH) is a family of rare, life-threatening genetic liver disorders characterized by elevated production and excretion of oxalate. To date, the clinical and economic burden associated with PH has not been well characterized due to the rarity of the disease and previous challenges with diagnostic coding that prevented proper identification of patients with PH in claims data. OBJECTIVE: To characterize the clinical and economic costs, as well as health care resource utilization (HCRU), associated with PH relative to a matched cohort of patients without PH. METHODS: Data from the IQVIA PharMetrics Plus Database were used to conduct a retrospective matched-cohort study to compare differences in clinical characteristics, HCRU, and pharmacy and medical costs in patients with PH compared with a matched cohort of patients without PH from January 2014 to December 2019. RESULTS: Overall, 324 patients were included in the PH cohort and 1,620 patients were in the non-PH cohort. The mean age of PH patients was 48.1 years, and approximately 58% of the sample were male. Significantly more patients in the PH cohort than the non-PH cohort were diagnosed with stage 2 chronic kidney disease (CKD; 3.1% vs 0.4%, respectively; P < 0.001), stage 3 CKD (4.6% vs 0.5%; P < 0.001), stage 4 CKD (2.5% vs 0.1%; P < 0.001), and stage 5 CKD or end-stage renal disease (ESRD; 2.2% vs 0.1%; P < 0.001). PH patients had a significantly higher mean Charlson Comorbidity Index composite score than patients in the non-PH cohort (0.79 vs 0.37; P < 0.001). HCRU was significantly higher in patients with PH. The PH cohort had a significantly higher proportion of patients with at least 1 visit to clinicians specializing in nephrology (19% vs 0.4%, respectively; P < 0.001), cardiology (22% vs 12%; P < 0.001), ophthalmology (16% vs 7%; P < 0.001), general surgery (9% vs 6%; P = 0.011), and urology (65% vs 6%; P < 0.001) compared with patients without PH. Mean total annual health care costs in the PH cohort were 65% higher than in the non-PH cohort ($22,549 vs $7,852, respectively; P < 0.001). Similar results were found for total prescription drug costs ($4,125 vs $2,464; P = 0.012). CONCLUSIONS: Despite the rarity of PH, patients with this disease incur substantial clinical and economic burden and may cause financial strain on the health care system. Additional research is warranted to understand the economic and clinical burden of PH stratified by the 3 subtypes of the disease. DISCLOSURES: Funding for this research was provided by Dicerna Pharmaceuticals. Mucha and Hoppe are employed by Dicerna Pharmaceuticals. Silber Miyasoto, Skaar, and Wang are employed by Trinity Life Sciences, which was contracted by Dicerna Pharmaceuticals to conduct the study analysis. Langman is consultant to Dicerna Pharmaceuticals. This study was presented as a poster at the AMCP Nexus 2020 (virtual), October 19-23, 2020, and American Society of Nephrology 2020 (virtual), October 19-25, 2020.

Differences in Diabetic Prescription Drug Utilization and Costs Among Patients With Diabetes Enrolled in Colorado Marketplace and Medicaid Plans, 2014-2015

Increasing prices of antidiabetic medications in the US have raised substantial concerns about the effects of drug affordability on diabetes care. There has been little rigorous evidence comparing the experiences of patients with diabetes across different types of insurance coverage. To compare the utilization patterns and costs of prescription drugs to treat diabetes among low-income adults with Medicaid vs those with Marketplace insurance in Colorado during 2014 and 2015. This cross-sectional study included diabetic patients enrolled in Colorado Medicaid and Marketplace plans who were aged 19 to 64 years and had incomes between 75% and 200% of the federal poverty level during 2014 and 2015. Data analysis was conducted from September 2020 to April 2021. Health insurance through Colorado Medicaid or Colorado's state-based Marketplace. Primary outcomes were drug utilization (prescription drug fills) and drug costs (total costs and out-of-pocket costs). The secondary outcome was months with an active prescription for noninsulin antidiabetic medications. An all payer claims database was combined with income data, and linear models were used to adjust for clinical and demographic confounders. Of 22 788 diabetic patients included in the study, 20 245 were enrolled in Medicaid and 2543 in a Marketplace plan. Marketplace-eligible individuals were older (mean [SD] age, 52.12 [10.60] vs 47.70 [11.33] years), and Medicaid-eligible individuals were more likely to be female (12 429 [61.4%] vs 1413 [55.6%]). Medicaid-eligible patients were significantly more likely than Marketplace-eligible patients to fill prescriptions for dipeptidyl peptidase 4 inhibitors (adjusted difference, -3.7%; 95% CI, -5.3 to -2.1; P < .001) and sulfonylureas (adjusted difference, -6.6%; 95% CI, -8.9 to -4.3; P < .001). Overall rates of insulin use were similar in the 2 groups (adjusted difference, -2.3%; -5.1 to 0.5; P = .11). Out-of-pocket costs for noninsulin medications were 84.4% to 95.2% lower and total costs were 9.4% to 54.2% lower in Medicaid than in Marketplace plans. Out-of-pocket costs for insulin were 76.7% to 94.7% lower in Medicaid than in Marketplace plans, whereas differences in total insulin costs were mixed. The percentage of months of apparent active medication coverage was similar between the 2 groups for 4 of 5 drug classes examined, with Marketplace-eligible patients having a greater percentage of months than Medicaid-eligible patients for sulfonylureas (adjusted difference, 5.3%; 95% CI, 0.3%-10.4%; P = .04). In this cross-sectional study, drug utilization across multiple drug classes was higher and drug costs were significantly lower for adults with diabetes enrolled in Medicaid than for those with subsidized Marketplace plans. Patients with Marketplace coverage had a similar percentage of months with an active prescription as patients with Medicaid coverage.

Evaluation of COVID-19 Treatments in Iran in Comparison with Local Therapeutic Recommendations: A Population-Level Study on Utilization and Costs of Prescription Drugs.

Objective:In this study, we assess population-level data of COVID-19 treatments in Iran compared to Ministry of Health (MOH)-published guidelines to gain a better insight into the quality of care for this disease.Methods:National sales data of each recommended and nonrecommended COVID-19 medicine were used to proxy utilization between March 21, 2020, and March 21, 2021, or Iranian year 1399. COVID-19–attributed sales volume and number of patients were estimated by adjusting sales data with pre-COVID-19 average growth rate, recommended dose, and duration of treatment. Next, they were compared with the MOH guidelines in outpatient and inpatient settings. Furthermore, the list of top 10 molecules of the market and top 10 COVID-19–indicated molecules in terms of values were extracted to assess the economic burden of COVID-19 prescription drugs and their share.Findings:The estimated number of patients receiving COVID-19 treatments in some outpatient medicines such as recommended hydroxychloroquine was over 2.2 million. Favipiravir and remdesivir were collectively about two inpatient medicines 260,000; however, neither of these two medicines was recommended in the MOH guidelines. In some fewer specific medicines such as dexamethasone, prednisolone, azithromycin, and naproxen, the estimated number of COVID-19–attributed patients were incomparable with the officially announced number of confirmed cases in the year of study, which could be related to nonconfirmed diagnosed cases, irrational use, or prescribing, or limitations of our data and study. The total COVID-19–attributed market of candidate medicines was over 15 trillion IR Rials (almost 4.3% of the total market). Remdesivir, with over 60% of the total COVID-19 attributed market, followed by favipiravir, was among the highest value medicines.Conclusion:Despite the release of the COVID-19 guideline by Iran MOH, misalignment in the enforcement of decisions was a serious weakness (cases of favipiravir and remdesivir). This weakness led to some economic burden on the health-care system and raised ethical concerns.

Pharmacoeconomic aspects of pharmaceutical ethics

Nowadays, ethical standards of marketing, pricing, and safety strategies conducted by pharmaceutical manufacturers have declined significantly, which raises the question of health-care quality. The company's main objective has become to maximize profit and it is often done by unethical and deceptive marketing, implementation of direct-to-consumer ads, and educational meetings with a promotional character. One of the modern health-care areas, which aims to solve the ethical issues of the drug market, is pharmacoeconomics. The goal of pharmacoeconomics is not only the economic evaluation of various medical programs and pharmacological drugs but also the development of recommendations for the most efficient use of health resources and determining the right pricing and reimbursement strategy. Moreover, the use of the formulary system, which is the functioning tool of the evidence-based medicine (EBM), aims to provide an access to a wide range of certified and high-quality medicines that are recognized on the world market. Generics are considered a great substitutional option to the “ordinary” drugs due to their affordable price as the cost of prescription drugs in the world continues to be a source of concern. Another tool for providing affordable drug's prices is the reimbursement system, which offers a range of essential medicines at the reduced cost and can be product, disease, population, or consumption specific.

Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease.

Patients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression. We conducted a retrospective cohort study of adults with CKD and eGFR of 15-59 ml/min per 1.73 m2 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs. In total, 1003 adults were included in the study. Within the eGFR of 15-29 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (P=0.008), $23,423 versus $11,231 (P<0.001), and $21,853 versus $16,757 (P=0.01), respectively. Within the eGFR of 30-59 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (P=0.10), $13,414 versus $10,370 (P=0.08), and $20,394 versus $14,902 (P=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure. In patients with CKD and eGFR of 15-59 ml/min per 1.73 m2 followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15-29 ml/min per 1.73 m2 had stronger association with hospitalizations costs, physician visits, and drug utilizations.

Who Pays for Gifts to Physicians? Heterogeneous Effects of Industry Payments on Drug Costs

This paper estimates the impact of gifts - monetary or in-kind payments - from pharmaceutical firms on physicians' prescription decisions and drug costs in the US. Using exhaustive micro data on prescriptions for anti-diabetic drugs from Medicare Part D, we find that payments cause physicians to prescribe more brand drugs. On average, for every dollar spent, payments generate a $6 increase in drug costs. We then estimate heterogeneous causal effects via machine-learning methods. We find large heterogeneity in responses to payments across physicians. Differences are predominantly explained by the insurance coverage of patients: physicians prescribe more brand drugs in response to payments when patients benefit from subsidies that reduce out-of-pocket drug costs. Finally, we estimate that a gift ban would reduce drug costs to treat diabetes by 3%.

Ապահովագրության շրջանակներում դեղերի փոխհատուցման հիմնական սխեմաների համեմատական վերլուծություն / Comparative Analysis of the Main Drug Reimbursement Schemes in Insurance

One component of the health insurance system is drug insurance, which provides full or partial reimbursement for the cost of prescription drugs. Expenditures on pharmaceuticals account for a large proportion of total health care costs. The regular distribution of drugs to people in adequate quantities and with guaranteed quality presents one of the largest challenges for the government of every country. Both developed and developing countries have an extensive experience with the primary insurance based on drug reimbursement programs, making it crucial to evaluate the key characteristics of these programs. The required medical insurance system and its essential component, the drug reimbursement program, have not yet been implemented in the Republic of Armenia, making it a significant and pertinent issue for study. The authors studied and compared the drug reimbursement schemes in selected countries, discussed the criteria for drug reimbursement, the features of the compilation of reimbursement lists, and presented the main approaches to the price policy development in the field of drug reimbursement. The study also analyses the main mechanisms of reimbursement of medicines operating in the RA, population groups and diseases included in the framework of reimbursement. The research examines the primary mechanisms of drug reimbursement in the RA, as well as population groups and diseases covered by the framework of reimbursement. The findings of the study demonstrate the lack of a universal model for drug reimbursement. Instead, developed nations and those with similar economies develop their own public health protection models. These models, while differ in organizational aspects, contain common components including population categories, reimbursement lists, reimbursement rates, price regulation systems, and other components that should serve as a guide when creating the drug insurance model in the RA.

Build Back Better Act could affect US community-based oncology practices.

Passed in the USA on Nov 19, 2021, the Build Back Better (BBB) Act, which intends to reduce the costs of prescription drugs and health care in the country, could lead to a substantial decrease in payments for Medicare—the government health insurance programme for people aged 65 years and older—to independent and community-based oncology practices, a new analysis has found.