Amber M. Goedken

Effect of cost sharing on prescription drug use by Medicare beneficiaries prior to the Medicare Drug Benefit and potential adverse selection in the benefit

OBJECTIVE To (1) describe prescription drug cost sharing and benefit structures faced by seniors before implementation of the Medicare drug benefit, (2) examine the relationship between prescription drug benefit structure and prescription drug use by seniors prior to Medicare drug benefit, and (3) examine factors predicting intention to enroll in the Medicare drug benefit. DESIGN Cross-sectional study. SETTING Internet-based survey administered on behalf of the researchers by Harris Interactive in October 2005. PARTICIPANTS Harris Interactive maintains a panel of individuals who have opted to participate in online surveys. Individuals from this panel who were English speaking, 65 years of age or older, U.S. residents, and enrolled in Medicare were invited to participate. INTERVENTION The survey collected information on prescription coverage, prescription use, intention to enroll in the Medicare drug benefit, health status, and demographics. MAIN OUTCOME MEASURES Number of prescriptions used by a beneficiary in the month before the survey and the intention of the beneficiary to enroll in the Medicare drug benefit. RESULTS Beneficiaries were enrolled in plans with a wide variety of benefit structures and cost-sharing amounts. Prescription drug use fell with higher copayment ranks and average coinsurance but not at the P < 0.05 level. Among poorer individuals, the relationship between copayment rank and use was significant. Individuals reporting worse health status and a higher number of prescriptions indicated greater intention to enroll in the Medicare drug benefit, suggesting possible adverse selection. CONCLUSION Prescription use decreased as cost sharing increased with mixed significance. There was evidence of potential adverse selection in the Medicare drug benefit.

Impact of cost sharing on prescription drugs used by Medicare beneficiaries

BACKGROUND Incentive-based prescription drug cost sharing can encourage seniors to use generic medications. Little information exists about prescription drug cost sharing and generic use in employer-sponsored plans after the implementation of Medicare Part D. OBJECTIVES To compare prescription drug cost sharing across prescription insurance type for Medicare beneficiaries after Medicare Part D, to assess the impact of that cost sharing on the number of medications used, and to examine how generic utilization rates differ before and after Medicare Part D and across the type of insurance. METHODS This longitudinal study of Medicare beneficiaries aged 65 years and older used Web-based surveys administered in 2005 and 2007 by Harris Interactive((R)) to collect information on prescription drug coverage and medication use. Co-payment plans were categorized as low, medium, or high co-payment plans. Multiple regression was used to assess the impact of co-payment rank on the number of prescription drugs. t-Tests and analysis of variance were used to compare generic use over time and between coverage types. RESULTS One thousand two hundred twenty and 1024 respondents completed the baseline and follow-up surveys, respectively. Among 3-tier co-payment plans, brand drug co-payments were higher for Part D plans (

Continuous Medication Monitoring (CoMM): A foundational model to support the clinical work of community pharmacists

26 for preferred brand and

Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with usual care.

55 for nonpreferred brand) than employer-based plans (

Effect of Medicare Part D and insurance type on Medicare beneficiary access to prescription medication and use of prescription cost-saving measures

20 for preferred brand and

Development of a medication monitoring attitude measure using a mixed methods item development process

39 for nonpreferred brand). Co-payment was not a significant predictor for the number of prescription drugs. Generic use was lowest among beneficiaries in employer plans both before and after Part D. In 2007, generic use among beneficiaries with Part D was not significantly different from the generic use for beneficiaries with no drug coverage. CONCLUSIONS Medicare beneficiaries in Part D had higher cost sharing amounts than those with employer coverage, but higher cost sharing was not significantly linked to lower prescription use. Generic use for Part D beneficiaries was higher than that for beneficiaries with employer coverage but the same as that for beneficiaries without drug coverage.

Instrumental variable methods to assess quality of care the marginal effects of process-of-care on blood pressure change and treatment costs.

Background Under the Continuous Medication Monitoring (CoMM) approach, community pharmacists prevent, identify, resolve, and document drug therapy problems during the dispensing process. Objective To describe the patients receiving CoMM interventions and the pattern of delivery of CoMM interventions. Methods Pharmacy dispensing and clinical records were reviewed for patients filling at least one prescription and receiving at least one continuous medication monitoring intervention at a community pharmacy from April 2014 through March 2015. The proportion of patients receiving an intervention type and the number of interventions per patient were computed. Results Nearly 2500 patients received 16,986 continuous medication monitoring interventions over the year. The average age of the patients receiving the interventions was 59.1 years, and they filled an average of 8.0 unique medications. An average of 6.8 interventions was delivered to each patient. About half (49.7%) of interventions addressed drug therapy problems. The pharmacists delivered 3.0 patient counseling and education and 3.4 drug therapy problem interventions per patient on average. Conclusion There are many opportunities to improve patients’ medication use that can be identified and addressed under a Continuous Medication Monitoring model. Movement to this model of practice is desirable, but changes are needed to facilitate the shift.

Medication-Related Problems Identified Through Continuous Medication Monitoring

Objective: To estimate long-term costs and outcomes attributable to a physician–pharmacist collaborative intervention compared with physician management alone for treating essential hypertension. Methods: A Markov model cohort simulation with a 6-month cycle length to predict acute coronary syndrome, stroke, and heart failure throughout lifetime was performed. A cohort of 399 patients was obtained from two prospective, cluster randomized controlled clinical trials implementing physician–pharmacist collaborative interventions in community-based medical offices in the Midwest, USA. Framingham risk equations and other algorithms were used to predict the vascular diseases. SBP reduction due to the interventions deteriorated until 5 years. Direct medical costs using a payer perspective were adjusted to 2015 dollar value, and the main outcome was quality-adjusted life years (QALYs); both were discounted at 3%. The intervention costs were estimated from the trials, whereas the remaining parameters were from published studies. A series of sensitivity analyses including changing patient risks of vascular diseases, probabilistic sensitivity analysis, and a cost-effectiveness acceptability curve were performed. Results: The lifetime incremental costs were

Geographic variation in inhaled corticosteroid use for children with persistent asthma in Medicaid

26 807.83 per QALY (QALYs gained = 0.14). The intervention provided the greatest benefit for the high-risk patients, moderate benefit for the trial patients, and the lowest benefit for the low-risk patients. If a payer is willing to pay

Provider Visits for Asthma: Potential Barriers for Insured Children

50 000 per QALY gained, in 48.6% of the time the intervention would be cost-effective. Conclusion: Team-based care such as a physician–pharmacist collaboration appears to be a cost-effective strategy for treating hypertension. The intervention is most cost-effective for high-risk patients.