Insurance Coverage for Prescription Drugs

Medical Care ◽  
1999 ◽  
Vol 37 (9) ◽  
pp. 926-936 ◽  
Author(s):  
Lee A. Lillard ◽  
Jeannette Rogowski ◽  
Raynard Kington
Keyword(s):  
Prescription Drugs ◽  
Insurance Coverage

Communication of Drug Affordability between Physicians and Elderly Patients

2003 ◽  
Vol 19 (5) ◽  
pp. 271-277 ◽  
Author(s):  
K Tom Xu ◽  
Brian K Irons
Keyword(s):  
Elderly Patients ◽  
Prescription Drugs ◽  
Telephone Survey ◽  
Insurance Coverage ◽  
Physician Visits ◽  
Patient Medication ◽  
Prescription Drug Use ◽  
Drug Affordability ◽  
Nonfinancial Factors ◽  
Improve Patient

Objective: To identify characteristics among elderly patients associated with patient–provider communications regarding affordability of medications in prescribing and dispensing. Methods: Telephone survey data from consumers ≥65 years old collected in the Texas Tech 5000 Survey were used. The sample size for the analyses was 2,360. Demographics, insurance, financial factors, nonfinancial factors, prescription drug use, and health status were used to identify which subgroup of elderly patients recalled communication with their providers regarding the affordability of prescriptions. Statistical analyses included bivariate analyses and a multivariate logistic regression. Results: Eleven percent of the respondents reported being asked by their physicians whether they could afford prescription drugs. In the multivariate analysis, gender, race, insurance coverage for prescriptions, income, number of physician visits, out-of-pocket expenditure for prescriptions, health, and physicians' participatory decision-making score were found to be associated with patient–provider communications regarding affordability of medications. Conclusions: Further research needs to be conducted to identify ways to improve patient–provider relationships to facilitate communication regarding affordability of medications among elderly patients. Improved communication or sensitivity to prescription affordability has the potential to increase patient medication adherence and improve clinical outcomes.

scholarly journals Financial Toxicity in Adults With Cancer: Adverse Outcomes and Noncompliance

2018 ◽  
Vol 14 (11) ◽  
pp. e665-e673 ◽  
Author(s):  
Thomas G. Knight ◽  
Allison M. Deal ◽  
Stacie B. Dusetzina ◽  
Hyman B. Muss ◽  
Seul Ki Choi ◽  
...  
Keyword(s):  
Prescription Drugs ◽  
Cancer Care ◽  
Insurance Coverage ◽  
Adverse Outcomes ◽  
Financial Toxicity ◽  
Recommended Care ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Medical Noncompliance ◽  
Health Registry

Purpose: Because of the escalating cost of cancer care coupled with high insurance deductibles, premiums, and uninsured populations, patients with cancer are affected by treatment-related financial harm, known as financial toxicity. The purpose of this study was to describe individuals reporting financial toxicity and to identify rates of and reasons for affordability-related treatment noncompliance. Methods: From May 2010 to November 2015, adult patients (age ≥ 18 years) with cancer were identified from a Health Registry/Cancer Survivorship Cohort. Financial toxicity was defined as agreement with the phrase “You have to pay for more medical care than you can afford” from the Patient Satisfaction Questionnaire-18. Logistic regression and Fisher exact tests were used to compare groups. Results: Of 1,988 participants, 524 (26%) reported financial toxicity. Patients reporting financial toxicity were more likely age 65 years or younger, female, nonwhite, non-English speaking, not married, less educated, and to have received a diagnosis more recently (all P < .001). Participants with financial toxicity were more likely to report noncompliance with medication, owing to inability to afford prescription drugs (relative risk [RR], 3.55; 95% CI, 2.53 to 4.98), and reported forgoing mental health care (RR, 3.89; 95% CI, 2.04 to 7.45), doctor’s visits (RR, 2.98; 95% CI, 1.97 to 4.51), and medical tests (RR, 2.54; 95% CI, 1.49 to 4.34). The most endorsed reasons for delayed care were not having insurance coverage and being unable to afford household expenses. Conclusion: More than 25% of adults with cancer reported financial toxicity that was associated with an increased risk for medical noncompliance. Financial toxicity remains a major issue in cancer care, and efforts are needed to ensure patients experiencing high levels of financial toxicity are able to access recommended care.

Exploring Prescription Drug Coverage and Drug Use for Older Americans

2002 ◽  
Vol 36 (11) ◽  
pp. 1704-1711 ◽  
Author(s):  
David A Mott ◽  
Jon C Schommer
Keyword(s):  
Drug Use ◽  
Prescription Drug ◽  
Prescription Drugs ◽  
Older Persons ◽  
Insurance Coverage ◽  
Drug Coverage ◽  
Prescription Drug Coverage ◽  
Older Americans ◽  
Drug Insurance ◽  
Prescription Drug Insurance

OBJECTIVE: To describe existing prescription drug insurance coverage for older Americans, to describe out-of-pocket payment levels per prescription associated with service benefit prescription drug plans used by older persons, and to examine the association of prescription drug coverage types with the reported use of prescription drugs by older persons. PATIENTS AND METHODS: Data were obtained from a national survey of 1570 community-dwelling older persons (≥65 y) conducted in June 1998. A 2-part utilization model was estimated using logistic regression and ordinary least-squares regression. RESULTS: Data from 310 respondents were used for analysis. Overall, 66.1% of respondents reported having prescription drug insurance coverage. A majority (76.6%) of respondents having private drug coverage reported having a service benefit plan (requiring copayment or coinsurance amount to be paid for each prescription). The median copayment per brand name and generic prescription for persons reporting having coverage by service benefit plans was $10 and $5, respectively. CONCLUSIONS: Overall, a majority of older persons reported paying relatively small amounts out-of-pocket per prescription during 1998. Among persons who reported having drug insurance coverage, there were no statistically significant differences in the reported number of drugs used daily, regardless of out-of-pocket payment amount per prescription. Patient need and level of past drug use were significantly associated with both the likelihood of using any prescription drugs and the level of use among users. More research is needed to examine differences in drug expenditures and characteristics of drugs used across prescription drug insurance types for older persons.

Prescription Drug Priorities under the Biden Administration

2021 ◽  
Author(s):  
Kyle A. Gavulic ◽  
Stacie B. Dusetzina
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Prescription Drug ◽  
Prescription Drugs ◽  
Insurance Coverage ◽  
Public Support ◽  
Economic Downturn ◽  
Drug Spending ◽  
Drug Prices ◽  
Prescription Drug Spending

Abstract In January 2021, the incoming Biden administration will inherit urgent priorities to curb health care spending and expand health care coverage to millions of Americans while also addressing the COVID-19 pandemic and resulting economic downturn. Among these competing priorities is the issue of access to and affordability of prescription drugs. Here, we outline Biden’s plan to directly lower prescription drug spending for payers and patients and to expand access to prescription medications through improved health insurance coverage. These policies could provide important financial protections for Americans against high prescription drug prices. Despite widespread public support for addressing prescription drug prices, many of Biden’s plans rely on Congressional action, which will be complicated by the narrow majority held by Democrats in the House and an evenly divided Senate. However, there may be other opportunities to reduce prescription drug spending and improve health insurance enrollment among the uninsured. While directly lowering drug prices would provide the most widespread savings for payers and patients alike, any successful effort to increase the number of Americans enrolled in health insurance or render it more affordable will still likely effectively lower patients’ out-of-pocket costs and improve access to prescription drugs.

Cancer history, health insurance coverage, and cost-related medication nonadherence and medication cost-coping strategies in the United States.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 68-68
Author(s):  
Jingxuan Zhao ◽  
Zhiyuan Zheng ◽  
Xuesong Han ◽  
Amy J. Davidoff ◽  
Matthew P. Banegas ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Survivors ◽  
Coping Strategies ◽  
Health Care Providers ◽  
Prescription Drugs ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Care Providers ◽  
Cancer History

68 Background: Policy makers, health care providers and patients are increasingly concerned about rising costs for prescription drugs and cost-related medication non-adherence (CRN). This study aims to evaluate the relationship between cancer history and CRN as well as cost-coping strategies, by health insurance coverage. Methods: We used the National Health Interview Survey data from 2013-2016 to identify adults age 18-64 with (n = 3 599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included a) CRN (skipping, taking less or delaying medication because of cost), and b) cost-coping strategies (requesting lower cost medication or using alternative therapies to save money). Separate multivariable logistic regressions were used to calculate the adjusted percentages of CRN and cost-coping strategies associated with cancer history, stratified by health insurance. Results: Cancer survivors reported higher percentages of CRN (14.5% vs. 12.1%, P < .001) and were slightly more likely to report using cost-coping strategies (24.4% vs. 22.8%, P = .060) compared with adults without a cancer history. The magnitude of differences in CRN by cancer history varied by insurance type (any private 10.2% vs. 8.6%, P = .034; public only 17.9% vs. 14.2%, P = .010; uninsured 41.0% vs. 33.2%, P = .064). Among the privately insured, the difference in CRN by cancer history was greatest among those enrolled in high deductible health plans (HDHP) without health saving accounts (HSA) (16.9% vs. 10.9%, P = .002). Regardless of cancer history, CRN and use of cost-coping strategies were highest for those uninsured, enrolled in HDHP and without HSA, and without prescription drugs coverage under their health plan (all P < .001). Conclusions: Cancer survivors are prone to CRN and more likely to use cost-coping strategies to minimize financial hardship. Expanding options for health insurance coverage and use of HSA, and prescription drug coverage may be effective strategies to address CRN.

scholarly journals Outcome-Based Pricing for New Pharmaceuticals via Rebates

2020 ◽  
Author(s):  
Elodie Adida
Keyword(s):  
Prescription Drugs ◽  
Insurance Coverage ◽  
Treatment Success ◽  
The United States ◽  
Healthcare Management ◽  
List Price ◽  
High Price ◽  
Transfer Payment ◽  
Pharmaceutical Firm ◽  
Risk Sensitive

The price of new brand-name prescription drugs has been rising fast in the United States. For example, the Amgen cholesterol drug Repatha had an initial list price of $14,523 per year. Patients, even with insurance coverage, must pay out of pocket a significant portion of this price. The treatment might not be successful, and this possibility reduces risk-sensitive patients’ incentives to purchase the drug. The high price together with the chance of negative treatment outcomes may lead payers to deny coverage for the drug. Outcome-based pricing has been proposed as a way to reallocate the risks and improve both payer resource allocation and patient access to drugs. According to an outcome-based rebate contract between Amgen and Harvard Pilgrim Healthcare, if a patient on Repatha suffers a heart attack or a stroke, both patient and insurer are refunded the cost of the drug. We use a stylized model to analyze the effect of outcome-based pricing via rebates. Our model captures the interaction between heterogenous, price-sensitive, risk-sensitive patients who decide whether to purchase the drug; a payer deciding whether to provide coverage for the drug; and a price-setting pharmaceutical firm seeking to maximize expected profits. We find that, in many cases, a pharmaceutical firm and payer cannot simultaneously benefit from outcome-based pricing, and who will benefit is determined by the probability of treatment success. Outcome-based pricing thus appears unlikely to solve the issues of high drug prices and high payer expenditures. However, supplementing outcome-based pricing with a transfer payment from firm to payer can make payer and firm (but not necessarily the patients) better off than under uniform pricing when the drug has a low chance of success. This paper was accepted by Stefan Scholtes, healthcare management.

Changes in employment and insurance for patients with cancer receiving safety net services.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 104-104
Author(s):  
Nicole Caston ◽  
Courtney Williams ◽  
Alan James Balch ◽  
Kathleen D. Gallagher ◽  
Gabrielle Betty Rocque
Keyword(s):  
Cancer Patients ◽  
Prescription Drugs ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Safety Net ◽  
Financial Assistance ◽  
Categorical Variables ◽  
Income Loss ◽  
Patients With Cancer ◽  
The Impact

104 Background: Under-resourced patients with cancer often face financial burdens due, not only to costs of treatment, but also from side effects that prevent individuals’ ability to work, which impact employment status and may cause insurance coverage loss. Financial assistance may be sought from safety net programs, which provide both material support and financial counseling. However, knowledge of the impact of cancer on employment and insurance in a population seeking safety net services is limited. Methods: This observational, cross-sectional study uses data on safety net services from a nationwide survey conducted in July 2017 and distributed by the Patient Advocate Foundation (PAF). The survey respondents included patients with cancer who received services from PAF from July 2016 to June 2017. Descriptive statistics were calculated using frequencies for categorical variables. Results: A total of 508 patients with cancer completed the survey. Most patients had a diagnosis of breast cancer (47%), followed by myeloma (13%), and prostate cancer (8%). The majority of patients reported that their illness affected their employment (67%); by either job loss (13%), income loss (24%), or inability to work as usual (27%). Of these patients, 27% lost their insurance coverage. Those able to enroll in a new insurance plan reported having more expensive rates (40%) and fewer covered services (36%) compared to their previous coverage. The most commonly utilized governmental safety net services were Social Security Disability Insurance (19%) and Medicaid (12%). Non-governmental safety net services such as financial assistance from non-profits (27%) and free medication from drug companies (13%) were also frequently used. Beyond their insurance coverage, cancer patients still needed assistance paying for diagnostic tests (18%), clinic visit fees (23%), and prescription drugs (15%) from the safety net program. Conclusions: Cancer patients commonly experience financial burden due to losses in employment and insurance, resulting in need for safety net programs. Further work is needed to identify approaches to reducing the adverse financial impact of cancer care.

scholarly journals Prescribing of antibiotics and other drugs to children from birth to age 5 in the United States: an observational study

2021 ◽  
Author(s):  
Stephen M Kissler ◽  
Bill Wang ◽  
Ateev Mehrotra ◽  
Michael Barnett ◽  
Yonatan M Grad
Keyword(s):  
United States ◽  
Observational Study ◽  
Prescription Drugs ◽  
Respiratory Infections ◽  
Antibiotic Prescription ◽  
Insurance Coverage ◽  
Antibiotic Use ◽  
The United States ◽  
Cumulative Number ◽  
The Us

Objectives. To inform efforts to reduce pediatric antibiotic use, we measured cumulative pediatric prescriptions for antibiotics and non-antibiotics and how this varies across geography and patient subgroups. Design. Observational study. Setting. United States, 2008-2018. Participants. 207,814 children under age 5 born in the United States between 2008 and 2013 with private medical insurance coverage. Interventions. None. Main outcome measures. Study outcomes included (1) the cumulative number of prescriptions received per child by age 5, (2) the proportion of these prescriptions that were attributable to respiratory infections, (3) the proportion of children who received at least one prescription by age 5, and (4) the fraction of total prescriptions received by the top 20% of prescription recipients. Results. Children received a mean of 8.21 (95% confidence interval [CI] (8.19, 8.22)) prescriptions for antibiotics and 9.81 (95% CI 9.80, 9.82) prescriptions for non-antibiotics by age five. Most antibiotic prescriptions (64%, 95% CI 63, 65) and many non-antibiotic prescriptions (25%, 95% CI 24, 26) were associated with outpatient visits for respiratory infections. By age 5, 93.8% (95% CI 93.4, 94.2) of children had received at least one antibiotic prescription while 88.3% (95% CI 87.9, 88.7) had received at least one prescription for a non-antibiotic. The top 20% of antibiotic prescription recipients accounted for 50.6% of all antibiotic prescriptions, and the top 20% of non-antibiotic prescription recipients accounted for 64.2% of all non-antibiotic prescriptions. Relative to other regions, the South featured higher prescribing rates and earlier time to first prescription. Conclusions. Children in the US receive a substantial number of antibiotics and other prescription drugs early in their lives, largely related to respiratory infections.

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