Cost-related medication nonadherence among elderly emergency department patients

Johnson, Riley; Harmon, Rochelle; Klammer, Catherine E.; Kumar, Abhishek; Greer, Conner; Beasley, Kyle; Wigstadt, Stephanie; Ambrose, Lisa; VanDePol, Eric; Jones, J. Stephen

doi:10.1016/j.ajem.2019.05.006

Cited by 6 publications

(9 citation statements)

References 7 publications

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Section: Contemporary Access To Prescription Medications and Issuesmentioning

confidence: 99%

“…Out-of-pocket retail cost of drugs for patients both with and without insurance, especially if not compensated for by drug manufacturers or charitable organizations, can be prohibitively expensive with high medication costs associated with nonadherence and emergency department admissions. 4 A common option for accessing cheaper prescription drugs is through companies that offer coupons, such as GoodRx, RxSaver, and SingleCare, who operate by comparing local drug prices by pharmacy to find current prices and discounts, offer free coupons, and pass savings on to the patients. However, coupons offered may be subject to price changes, expiration dates, or vary by geographical location, and when patients feel more financial burden from their insurance plan's cost sharing design, they indiscriminately cut back on both high-and low-value care.…”

Section: Contemporary Access To Prescription Medications and Issuesmentioning

confidence: 99%

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Urological Drug Price Stewardship: Potential Cost Savings Based on the Mark Cuban Cost Plus Drug Company Model

2023

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All authors reviewed the results and approved the final version of the manuscript. Data Availability: The data sets generated during and/or analyzed during the current study are available in the public Medicare Part D Prescribers by Provider and Drug data set (https:// data.cms.gov/provider-summary-by-type-of-service/medicare-part-d-prescribers/medicare-partd-prescribers-by-provider-and-drug) as well as the Mark Cuban Cost Plus Drug Company website (https://costplusdrugs.com/medications/).

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Section: Contemporary Access To Prescription Medications and Issuesmentioning

confidence: 99%

Section: Contemporary Access To Prescription Medications and Issuesmentioning

confidence: 99%

Urological Drug Price Stewardship: Potential Cost Savings Based on the Mark Cuban Cost Plus Drug Company Model

2023

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“…Differences in the (patho-)physiological and socioeconomic attributes of the elderly, when compared to younger counterparts, are well-known [ 6 , 7 , 8 ]. Emergency medicine, in particular, therefore, often poses challenges for medical personnel attending the elderly; indeed, complex situations, including multimorbidity, an increased risk of fall, nonadherence, and communication problems, tend to bind resources [ 8 , 9 , 10 ]. Together with the growth in numbers of this patient group, emergency departments face an increasing challenge to successfully manage the respective cases.…”

Section: Introductionmentioning

confidence: 99%

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna—An Overview

Krammel¹,

Drahohs

Hamp

et al. 2023

JCM

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Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18–64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18–64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92–2.94]. Elderly people were more likely (OR 1.68 [1.65–1.70]) to need emergency physicians, compared to 18–64 year-olds. Nursing home residents were twice (OR 2.11 [2.06–2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.

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“…2 Patients who struggle to afford their medications may cut pills in half, take them every other day, or forego them altogether. [3][4][5] Cost-related nonadherence is associated with a higher risk of financial instability, disease progression, hospitalization, and death. [6][7][8][9] To make matters worse, out-of-pocket costs are often difficult to predict, leaving patients and clinicians unable to account for costs in their medical decisions.…”

Section: Introductionmentioning

confidence: 99%

“… 2 Patients who struggle to afford their medications may cut pills in half, take them every other day, or forego them altogether. 3 , 4 , 5 Cost-related nonadherence is associated with a higher risk of financial instability, disease progression, hospitalization, and death. 6 , 7 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Accuracy of Physician Estimates of Out-of-Pocket Costs for Medication Filling

et al. 2021

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IMPORTANCE One-third of US residents have trouble paying their medical bills. They often turn to their physicians for help navigating health costs and insurance coverage.OBJECTIVE To determine whether physicians can accurately estimate out-of-pocket expenses when they are given all of the necessary information about a drug's price and a patient's insurance plan. DESIGN, SETTING, AND PARTICIPANTSThis national mail-in survey used a random sample of US physicians. The survey was sent to 900 outpatient physicians (300 each of primary care, gastroenterology, and rheumatology). Physicians were excluded if they were in training, worked primarily for the Veterans Administration or Indian Health Service, were retired, or reported 0% outpatient clinical effort. Analyses were performed from July to December 2020. MAIN OUTCOMES AND MEASURESIn a hypothetical vignette, a patient was prescribed a new drug costing $1000/month without insurance. A summary of her private insurance information was provided, including the plan's deductible, coinsurance rates, copays, and out-of-pocket maximum.Physicians were asked to estimate the drug's out-of-pocket cost at 4 time points between January and December, using the plan's 4 types of cost-sharing: (1) deductibles, (2) coinsurance, (3) copays, and (4) out-of-pocket maximums. Multivariate linear regression was used to assess differences in performance by specialty, adjusting for attitudes toward cost conversations, demographics, and clinical characteristics. RESULTSThe response rate was 45% (405 of 900) and 371 respondents met inclusion criteria.Among the respondents included in this study, 59% (n = 220) identified as male, 23% (n = 84) as Asian, 3% (n = 12) as Black, 6% (n = 24) as Hispanic, and 58% (n = 216) as White; 30% (n = 112) were primary care physicians, 35% (n = 128) were gastroenterologists, and 35% (n = 131) were rheumatologists; and the mean (SD) age was 49 (10) years. Overall, 52% of physicians (n = 192) accurately estimated costs before the deductible was met, 62% (n = 228) accurately used coinsurance information, 61% (n = 224) accurately used copay information, and 57% (n = 210) accurately estimated costs once the out-of-pocket maximum was met. Only 21% (n = 78) of physicians answered all 4 questions correctly. Ability to estimate out-of-pocket costs was not associated with specialty, attitudes toward cost conversations, or clinic characteristics. CONCLUSIONS AND RELEVANCEThis survey study found that many US physicians have difficulty estimating out-of-pocket costs, even when they have access to their patients' insurance plans. The mechanics involved in calculating real-time out-of-pocket costs are complex. These findings suggest that increased price transparency and simpler insurance cost-sharing mechanisms are needed to enable informed cost conversations at the point of prescribing.

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Cost-related medication nonadherence among elderly emergency department patients

Cited by 6 publications

References 7 publications

Urological Drug Price Stewardship: Potential Cost Savings Based on the Mark Cuban Cost Plus Drug Company Model

Urological Drug Price Stewardship: Potential Cost Savings Based on the Mark Cuban Cost Plus Drug Company Model

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna—An Overview

Accuracy of Physician Estimates of Out-of-Pocket Costs for Medication Filling

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