scholarly journals Effectiveness and Safety of Restarting Oral Anticoagulation in Patients with Atrial Fibrillation after an Intracranial Hemorrhage: Analysis of Medicare Part D Claims Data from 2010–2016

2019 ◽  
Vol 20 (5) ◽  
pp. 471-479 ◽  
Author(s):  
Terri V. Newman ◽  
Nemin Chen ◽  
Meiqi He ◽  
Samir Saba ◽  
Inmaculada Hernandez
Keyword(s):  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Oral Anticoagulation ◽  
Claims Data ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D

scholarly journals Concordance Between Electronic Health Record Data and Medicare Part D Claims Data for Oral Anticancer Drug Use

2020 ◽  
Vol 3 (4) ◽  
pp. e203821
Author(s):  
Manvi Sharma ◽  
Michael L. Johnson ◽  
Hui Zhao ◽  
Sharon H. Giordano ◽  
Holly M. Holmes
Keyword(s):  
Drug Use ◽  
Electronic Health Record ◽  
Anticancer Drug ◽  
Claims Data ◽  
Medicare Part D ◽  
Medicare Part ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Part D ◽  
Record Data

scholarly journals National Utilization Patterns of Warfarin Use in Older Patients with Atrial Fibrillation: A Population-Based Study of Medicare Part D Beneficiaries

2013 ◽  
Vol 47 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Mukaila A Raji ◽  
Matthew Lowery ◽  
Yu-Li Lin ◽  
Yong-Fang Kuo ◽  
Jacques Baillargeon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Low Income ◽  
Medicare Part D ◽  
Patient Characteristics ◽  
Population Based ◽  
Medicare Part ◽  
Part D ◽  
Stroke Incidence ◽  
Hospital Referral ◽  
Geographic Regions

BACKGROUND Although warfarin therapy reduces stroke incidence in patients with atrial fibrillation (AF), the rate of warfarin use in this population remains low. In 2008, the Medicare Part D program was expanded to pay for medications for Medicare enrollees. OBJECTIVE To examine rates and predictors of warfarin use in Medicare Part D beneficiaries with AF. METHODS This population-based retrospective cohort study used claims data from 41,447 Medicare beneficiaries aged 66 and older with at least 2 AF diagnoses in 2007 and at least 1 diagnosis in 2008. All subjects had continuous Medicare Part D prescription coverage in 2008. Statistical analysis using χ2 was used to examine differences in warfarin use by patient characteristics (age, ethnicity, sex, Medicaid eligibility, comorbidities, contraindications to warfarin, and whether they visited a cardiologist or a primary care physician [PCP]), CHADS2 score (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack; higher scores indicate higher risks of stroke), and geographic regions. Using hierarchical generalized linear models restricted to subjects without warfarin contraindications (n = 34,947), we examined the effect of patient characteristics and geographic regions on warfarin use. RESULTS The overall warfarin use rate was 66.8%. The warfarin use rates varied between hospital referral regions, with highest rates in the Midwestern states and lowest rates in the South. The regional variation persisted even after adjustment for patient characteristics. Multivariable analysis showed that the odds of being on warfarin decreased significantly with age and increasing comorbidity, in blacks, and among those with low income. Seeing a cardiologist (OR 1.10; 95% CI 1.05–1.16), having a PCP (OR 1.23; 95% CI 1.17–1.29), and CHADS2 score of 2 or greater (OR 1.09; 95% CI 1.01–1.17) were associated with increased odds of warfarin use. CONCLUSIONS Warfarin use rates vary by patient characteristics and region, with higher rates among residents of the Midwest and among patients seen by cardiologists and PCPs. Preventing stroke-related disability in AF requires implementation of evidence-based initiatives to increase warfarin use.

Abstract P634: Contemporary Trends of Oral Anticoagulant Utilization Among Texas Medicare Beneficiaries With Atrial Fibrillation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Youngran Kim ◽  
Trudy Krause ◽  
Edip Gurol ◽  
Louise D McCullough ◽  
Farhaan S Vahidy
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Claims Data ◽  
Medicare Part D ◽  
P Value ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Medical Claims ◽  
Increasing Trends

Introductions: Underutilization of oral anticoagulation (OAC) drugs among atrial fibrillation (AF) patients has been reported. We provide contemporary trends for utilization of warfarin and novel OACs (NOACs) among Medicare beneficiaries with AF in Texas. Methods: Using Texas Medicare Fee-for-Service claims data for 2014-2017, AF patients were identified if they had at least one inpatient or two outpatient claims with a diagnosis of AF using ICD 9/10 codes. AF patients having any medical claims with ICD 9/10 or CPT codes indicating vulvar stenosis or the presence of valve replacement were excluded. OACs included warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban and the use of a drug was assumed if the prescription was filled. The percentage of patients on OAC among AF patients, who were enrolled in Medicare Part D in the measurement year were reported with 95% CI and p-value for trends both overall and by CHA 2 DS 2 -VASc score and renal function. Results: Of 216,602 AF patients, 57% did not receive any OAC during any measurement year. Overall OAC utilization increased from 35.8% (35.4-36.2) in 2014 to 41.6 % (41.3-41.8) in 2017 (p <0.001). This increase was driven by NOAC use which increased from 18.6% (18.3-18.9) in 2014 to 29.3% (29.0-29.5) in 2017 (p <0.001) while the proportion of warfarin users decreased from 17.2% (16.9-17.5) in 2014 to 12.3% (12.1-12.5) in 2017 (p <0.001). Increasing trends for NOAC use and decreasing trends for warfarin were observed regardless of CHA 2 DS 2 -VASc scores and levels of renal function. Conclusions: The OAC use has been increasing but about 6 out of 10 AF patients do not receive OAC despite high CHA 2 DS 2 -VASc scores. Targeted strategies are required to address OAC underutilization among AF patients.

Trend in Tyrosine Kinase Inhibitor Utilization, Price, and Out-of-Pocket Costs in Patients With Chronic Myelogenous Leukemia

2021 ◽  
pp. OP.20.00967
Author(s):  
Brian Talon ◽  
Gregory S. Calip ◽  
Todd A. Lee ◽  
Lisa K. Sharp ◽  
Pritesh Patel ◽  
...  
Keyword(s):  
Tyrosine Kinase ◽  
Chronic Myelogenous Leukemia ◽  
Claims Data ◽  
Financial Burden ◽  
Medicare Part D ◽  
Myelogenous Leukemia ◽  
Medicare Part ◽  
Part D ◽  
Drug Prices ◽  
Increasing Trend

PURPOSE: Treatment of chronic myelogenous leukemia (CML) with tyrosine kinase inhibitors (TKIs) has improved survival but is associated with significant financial burden. We measured the annual trend in TKI utilization, Medicare gross payment, and patient out-of-pocket (OOP) expenditure from 2007 to 2016. METHODS: We used SEER linked to Medicare part-D claims data to identify prevalent CML cases from 2007 to 2016. TKI utilization was measured as the proportion of cases with at least one TKI fill in each year. Average TKI gross payment and median per-member per-month OOP expenditure were calculated from claims data and plotted annually from 2007 to 2016. Year-to-year percent change in gross payment and OOP expenditure was compared with inflation indices. RESULTS: The cohort included 3,189 CML cases with at least one TKI claim. The proportion of prevalent patients with a TKI fill in a year increased from 17.9% in 2007 to 52.8% in 2015. The average annual gross payment per 30-day supply of a TKI increased by an average of 12.8% throughout the period from $9,000 to $10,000 US dollars in 2016. There was no increasing trend in median OOP expenditure per 30-day supply, which varied between $450 and $600 US dollars. CONCLUSION: Rising TKI use and TKI drug prices place considerable financial pressure on Medicare part-D insurers. Although there was no increasing trend in OOP expenditure, it may be burdensome for Medicare patients who are likely retired on a fixed income. Our findings support legislation that mitigates increasing drug prices to protect the Medicare system and its beneficiaries.

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