How to Effectively Decrease Patient Co-Payments of High-Cost Drugs Through Innovation: Lessons From the Karmanos Specialty Pharmacy

2021 ◽  
pp. OP.21.00207
Author(s):  
Erlene K. Seymour ◽  
Lucius Daniel ◽  
Eva Pointer ◽  
Jordan Julian ◽  
Stephen T. Smith ◽  
...  
Keyword(s):  
Drug Cost ◽  
Financial Burden ◽  
Data Set ◽  
Patients With Cancer ◽  
Subset Analysis ◽  
Delivery Times ◽  
Patient Assistance ◽  
Medicare Patients ◽  
Specialty Pharmacy ◽  
Insured Patients

PURPOSE: High-cost drugs impose a financial burden on patients with cancer. Karmanos Specialty Pharmacy (KSP) developed a process to automate financial assistance (FA) applications to decrease patient drug cost. We evaluate the outcomes of this program on cost to patients and payers. METHODS: This is an observational, retrospective study of the KSP claims data set from January to December 2019, accessed by 13 statewide cancer centers within Michigan. Drug cost of patients, payers, FA (funds to lower patient drug cost), and types of FA were obtained. A subset analysis was performed to determine drug delivery times. RESULTS: In 2019, 869 prescriptions and 1,722 prescription fills were provided to 463 patients through KSP. The total cost of drug claims was approximately $10 million US dollars (USD) among Medicare patients (58%), approximately $3.4 million USD for privately insured patients (20%), and approximately $3.7 million USD for Medicaid patients (22%). Twenty-seven percent of patients (22% of all prescription fills) required additional FA with initial total co-payment claims of $335,216 USD. $280,988 USD of FA was obtained, which substantially lowered total patient costs by 81%. $250,818 USD of FA obtained was from foundation grants (327 fills), and $21,441 USD from manufacturer co-pay cards (47 fills). An additional $12,260 USD (12 fills) from a Karmanos Patient Assistance Fund was used. There was high dependence on foundation grant assistance among Medicare patients (33% of claims). In a subset analysis, the median time from prescription written to delivery to the patient was < 7 days (0-56 days). CONCLUSION: Twenty-seven percent of patients (22% of prescriptions fills) in 2019 required additional FA for high-cost drugs. KSP substantially reduced patient cost by implementing an efficient process using additional pharmacy assistants to obtain FA.

Trends in patient copays for hospital and office-based chemotherapy 2005-2012 for Medicare and commercially insured patients.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 260-260
Author(s):  
Kathleen A. Foley ◽  
Rebecca Bechhold
Keyword(s):  
Patient Adherence ◽  
Financial Burden ◽  
Chemotherapy Administration ◽  
Medicare Patients ◽  
The Mean ◽  
Commercial Health Insurance ◽  
Financial Burdens ◽  
Insured Patients ◽  
Over Time

260 Background: With the growing shift towards chemotherapy administration in outpatient hospital settings (OHS) versus office-based settings (OBS), we sought to characterize the percent of patients with a copay and the mean copayment by setting and insurance type over time. Methods: Using the MarketScan Research Databases, first administrations of bevacizumab and trastuzumab were identified from 1/1/2005 through 12/31/2012 for patients with commercial or employer-sponsored supplemental Medicare insurance. Bevacizumab claims were excluded if the claim had a diagnosis related to macular degeneration or other eye disease. All claims were identified in OHS, OBS, or other setting. Results: The percent of patients with a copayment varied by insurer and setting but within each group remained fairly consistent over time. The average percent with a copay was 14% OHS and 19% OBS for commercial and 17% OHS and 28% OBS for Medicare patients. Per administration copayment amounts varied over time, with peaks of $978 OHS and $631 OBS for commercial in 2012 and $721 OHS and $464 OBS in 2011 for Medicare with 2012 Medicare copayments declining somewhat for bevacizumab. For herceptin peak mean copayments were $886 and $439 in 2012 for OHS and OBS commercial patients, respectively, and $458 and $474 in 2010 with declines in 2011 and 2012 for Medicare, respectively. Commercial patients receiving care in OHS settings consistently faced copayments that were 50 to 100% higher those paid by patients receiving chemotherapy in OBS. Copayment differentials were smaller for Medicare patients. Conclusions: As more patients are receiving care in OHS, these data imply significant financial burdens on patients, especially for those with commercial health insurance. Additional research is necessary to understand the overall cost burden on patients and whether the shift to OHS-based care has negatively impacted patient adherence or quality of life due to financial burden. [Table: see text]

scholarly journals Socioeconomic Factors and Survival of Multiple Myeloma Patients

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 590
Author(s):  
Kamal Chamoun ◽  
Amin Firoozmand ◽  
Paolo Caimi ◽  
Pingfu Fu ◽  
Shufen Cao ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Socioeconomic Factors ◽  
Hematopoietic Cell Transplantation ◽  
Financial Burden ◽  
Private Insurance ◽  
Median Income ◽  
The Us ◽  
Medicare Patients ◽  
Insured Patients ◽  
Privately Insured

Background: Outcome of Multiple Myeloma (MM) patients has improved as the result of the introduction of novel medications and use of autologous hematopoietic cell transplantation. However, this improvement comes at the expense of increased financial burden. It is largely unknown if socioeconomic factors influence MM survival. Methods: We used the National Cancer Database, a database that houses data on 70% of cancer patients in the US, to evaluate the effect of socioeconomic factors on the survival of 117,926 MM patients diagnosed between 2005 and 2014. Results: Patients aged ≥65 years who were privately insured lived longer than patients with Medicare (42 months vs. 31 months, respectively, p < 0.0001). Treatment in academic institutions led to better survival (HR: 1.49, 95% CI: 1.39, 1.59). Younger age, fewer comorbidities, treatment in academic centers, and living in a higher median income area were significantly associated with improved survival. After adjusting for confounders, survival of Medicare patients was similar to those with private insurance. However, the hazard of death remained higher for patients with Medicaid (HR: 1.59, 95% CI: 1.36, 1.87) or without insurance (HR: 1.62, 95% CI: 1.32, 1.99), compared to privately insured patients. Conclusion: Economic factors and treatment facility type play an important role in the survival of MM patients.

scholarly journals Adverse reactions of targeted therapy in cancer patients: a retrospective study of hospital medical data in China

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruofei Du ◽  
Xin Wang ◽  
Lixia Ma ◽  
Leon M. Larcher ◽  
Han Tang ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Cancer Patients ◽  
Adverse Reactions ◽  
Cox Regression ◽  
Target Therapy ◽  
Skin Damage ◽  
Data Set ◽  
Patients With Cancer ◽  
Number Of Patients ◽  
Significant Difference

Abstract Background The adverse reactions (ADRs) of targeted therapy were closely associated with treatment response, clinical outcome, quality of life (QoL) of patients with cancer. However, few studies presented the correlation between ADRs of targeted therapy and treatment effects among cancer patients. This study was to explore the characteristics of ADRs with targeted therapy and the prognosis of cancer patients based on the clinical data. Methods A retrospective secondary data analysis was conducted within an ADR data set including 2703 patients with targeted therapy from three Henan medical centers of China between January 2018 and December 2019. The significance was evaluated with chi-square test between groups with or without ADRs. Univariate and multivariate logistic regression with backward stepwise method were applied to assess the difference of pathological characteristics in patients with cancer. Using the univariate Cox regression method, the actuarial probability of overall survival was performed to compare the clinical outcomes between these two groups. Results A total of 485 patients were enrolled in this study. Of all patients, 61.0% (n = 296) occurred ADRs including skin damage, fatigue, mucosal damage, hypertension and gastrointestinal discomfort as the top 5 complications during the target therapy. And 62.1% of ADRs were mild to moderate, more than half of the ADRs occurred within one month, 68.6% ADRs lasted more than one month. Older patients (P = 0.022) and patients with lower education level (P = 0.036), more than 2 comorbidities (P = 0.021), longer medication time (P = 0.022), drug combination (P = 0.033) and intravenous administration (P = 0.019) were more likely to have ADRs. Those with ADRs were more likely to stop taking (P = 0.000), change (P = 0.000), adjust (P = 0.000), or not take the medicine on time (P = 0.000). The number of patients with recurrence (P = 0.000) and metastasis (P = 0.006) were statistically significant difference between ADRs and non-ADRs group. And the patients were significantly poor prognosis in ADRs groups compared with non-ADRs group. Conclusion The high incidence of ADRs would affect the treatment and prognosis of patients with cancer. We should pay more attention to these ADRs and develop effective management strategies.

scholarly journals EP.WE.409Stoma forming surgery – has lockdown changed our operative practice during COVID 19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ross Manson ◽  
Tracy Tallo ◽  
Isabell Robertson ◽  
John Anderson ◽  
Praveen Sharma ◽  
...  
Keyword(s):  
Loop Ileostomy ◽  
Retrospective Data ◽  
Curative Intent ◽  
Data Set ◽  
Patients With Cancer ◽  
Local Database ◽  
Stoma Formation ◽  
Retrospective Data Collection ◽  
Emergency Operating ◽  
Comparison Data

Abstract Aims This study aimed to establish whether the initial lockdown resulted in a shift towards emergency surgery, changes in stoma formation and in rate of surgery with curative intent. Methods A retrospective data collection was performed. Patients were identified using a local database of all patients with stomas. Data was collected from 16/03/20 to 16/09/20. A comparison data set was taken (16/03/19 to 16/09/19). Data was collected on whether the case was performed as an emergency; the type of stoma formed and whether the operation was performed with curative intent. Results Seventeen patients were identified in the 2020 cohort (age: 51-84, mean age: 67.6, M:F 10:7). Fourteen cases (82.4%) were performed as emergencies, three electively (17.6%). Six (35.3%) had end colostomies, three (17.6%) had loop colostomies, one (5.9%) had a caecostomy, four (23.5%) had an end ileostomy and three (17.6%) had a loop ileostomy. Ten operations were for patients with cancer, three (30%) were performed with curative intent. 38 patients were identified in the 2019 cohort (age: 28-85, mean age: 63.0, M:F 17:21). 23 (60.5%) were emergencies, fifteen (39.5%) were performed electively. Nine (23.7%) had end colostomies, eight (21.1%) had loop colostomies, three (7.9%) had caecostomies, ten (26.3%) had end ileostomies and nine (23.7%) had loop ileostomies. There were nineteen operations for cancer, eight (42.1%) were with curative intent. Conclusions Cessation of elective activity caused a shift towards emergency operating, with an associated shift towards surgery with non-curative intent. The distribution of stomas formed has not changed.

Quality and Consumer Choice in Healthcare: Evidence from Kidney Transplantation

2006 ◽  
Vol 5 (1) ◽  
Author(s):  
David H Howard
Keyword(s):  
Kidney Transplantation ◽  
Consumer Choice ◽  
Logit Model ◽  
Mixed Logit ◽  
Mixed Logit Model ◽  
Hospital Level ◽  
Standard Deviation Increase ◽  
Policy Debates ◽  
Medicare Patients ◽  
Insured Patients

AbstractMost studies of competition in health care focus on prices and costs, but concerns about quality play a central role in policy debates. If demand is inelastic to quality, then competition may reduce patient welfare. This study uses a dataset of patient registrations for kidney transplantation in conjunction with a mixed logit model to gauge consumers’ responsiveness to quality when choosing hospitals. Results indicate that at the hospital level, a one-standard deviation increase in the graft-failure rate is associated with a 6% decline in patient registrations. Privately-insured patients are more responsive to quality than Medicare patients, suggesting that insurers consider quality when contracting with providers.

scholarly journals Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review

2018 ◽  
Vol 44 (5) ◽  
pp. E6 ◽  
Author(s):  
Seungwon Yoon ◽  
Michael A. Mooney ◽  
Michael A. Bohl ◽  
John P. Sheehy ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Financial Burden ◽  
Vascular Lesions ◽  
Annual Growth Rate ◽  
Model Case ◽  
Patient Cost ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Insured Patients

OBJECTIVEWith drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.METHODSFor 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors’ institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time.RESULTSIn the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016).CONCLUSIONSEven after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

scholarly journals Identification of Pre-Diagnostic Metabolic Patterns for Glioma Using Subset Analysis of Matched Repeated Time Points

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3349
Author(s):  
Pär Jonsson ◽  
Henrik Antti ◽  
Florentin Späth ◽  
Beatrice Melin ◽  
Benny Björkblom
Keyword(s):  
Molecular Marker ◽  
Tumor Development ◽  
Data Simulation ◽  
Data Set ◽  
Time Points ◽  
Glutathione Biosynthesis ◽  
Subset Analysis ◽  
Biomarker Validation ◽  
Metabolomics Study ◽  
Longitudinal Sampling

Here, we present a strategy for early molecular marker pattern detection—Subset analysis of Matched Repeated Time points (SMART)—used in a mass-spectrometry-based metabolomics study of repeated blood samples from future glioma patients and their matched controls. The outcome from SMART is a predictive time span when disease-related changes are detectable, defined by time to diagnosis and time between longitudinal sampling, and visualization of molecular marker patterns related to future disease. For glioma, we detect significant changes in metabolite levels as early as eight years before diagnosis, with longitudinal follow up within seven years. Elevated blood plasma levels of myo-inositol, cysteine, N-acetylglucosamine, creatinine, glycine, proline, erythronic-, 4-hydroxyphenylacetic-, uric-, and aceturic acid were particularly evident in glioma cases. We use data simulation to ensure non-random events and a separate data set for biomarker validation. The latent biomarker, consisting of 15 interlinked and significantly altered metabolites, shows a strong correlation to oxidative metabolism, glutathione biosynthesis and monosaccharide metabolism, linked to known early events in tumor development. This study highlights the benefits of progression pattern analysis and provide a tool for the discovery of early markers of disease.

scholarly journals Coping with Prescription Drug Cost Sharing: Knowledge, Adherence, and Financial Burden

2008 ◽  
Vol 43 (2) ◽  
pp. 785-797 ◽  
Author(s):  
Mary Reed ◽  
Richard Brand ◽  
Joseph P. Newhouse ◽  
Joe V. Selby ◽  
John Hsu
Keyword(s):  
Prescription Drug ◽  
Drug Cost ◽  
Cost Sharing ◽  
Financial Burden ◽  
Prescription Drug Cost

scholarly journals Variation in the Cost of Radiation Therapy Among Medicare Patients With Cancer

2015 ◽  
Vol 11 (5) ◽  
pp. 403-409 ◽  
Author(s):  
Anthony J. Paravati ◽  
Isabel J. Boero ◽  
Daniel P. Triplett ◽  
Lindsay Hwang ◽  
Rayna K. Matsuno ◽  
...  
Keyword(s):  
Health Care ◽  
Radiation Therapy ◽  
Health Care Expenditure ◽  
Patients With Cancer ◽  
Medicare Patients ◽  
The Individual ◽  
The Cost

Factors unrelated to the individual patient accounted for the majority of variation in the cost of radiation therapy, suggesting potential inefficiency in health care expenditure.

scholarly journals Underuse of Hospice Care by Medicaid-Insured Patients With Stage IV Lung Cancer in New York and California

2013 ◽  
Vol 31 (20) ◽  
pp. 2569-2579 ◽  
Author(s):  
Jennifer W. Mack ◽  
Kun Chen ◽  
Francis P. Boscoe ◽  
Foster C. Gesten ◽  
Patrick J. Roohan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
New York ◽  
Care Facility ◽  
Stage Iv ◽  
Medicaid Patient ◽  
Patients Âgés ◽  
Medicare Patients ◽  
Stage Iv Lung Cancer ◽  
Hospice Use ◽  
Insured Patients

Purpose Medicare patients with advanced cancer have low rates of hospice use. We sought to evaluate hospice use among patients in Medicaid, which insures younger and indigent patients, relative to those in Medicare. Patients and Methods Using linked patient-level data from California (CA) and New York (NY) state cancer registries, state Medicaid programs, NY Medicare, and CA Surveillance, Epidemiology, and End Results–Medicare data, we identified 4,797 CA Medicaid patients and 4,001 NY Medicaid patients ages 21 to 64 years, as well as 27,416 CA Medicare patients and 16,496 NY Medicare patients ages ≥ 65 years who were diagnosed with stage IV lung cancer between 2002 and 2006. We evaluated hospice use, timing of enrollment, and location of death (inpatient hospice; long-term care facility or skilled nursing facility; acute care facility; home with hospice; or home without hospice). We used multiple logistic regressions to evaluate clinical and sociodemographic factors associated with hospice use. Results Although 53% (CA) and 44% (NY) of Medicare patients ages ≥ 65 years used hospice, fewer than one third of Medicaid-insured patients ages 21 to 64 years enrolled in hospice after a diagnosis of stage IV lung cancer (CA, 32%; NY, 24%). A minority of Medicaid patient deaths (CA, 19%; NY, 14%) occurred at home with hospice. Most Medicaid patient deaths were either in acute-care facilities (CA, 28%; NY, 36%) or at home without hospice (CA, 39%; NY, 41%). Patient race/ethnicity was not associated with hospice use among Medicaid patients. Conclusion Given low rates of hospice use among Medicaid enrollees and considerable evidence of suffering at the end of life, opportunities to improve palliative care delivery should be prioritized.

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