Out-of-Pocket Drug Costs and Drug Utilization Patterns of Postmenopausal Medicare Beneficiaries with Osteoporosis

Conwell, Leslie Jackson; Esposito, Dominick; Garavaglia, Susan B.; Meadows, Eric S.; Colby, Margaret; Herrera, Vivian; Goldfarb, Seth; Ball, Douglas E.; Marciniak, Martin

doi:10.1016/j.amjopharm.2011.04.009

Cited by 12 publications

(13 citation statements)

References 22 publications

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“…Clinical guidelines suggest that injectable ibandronate or zoledronate should be considered when the oral bisphosphates are contraindicated, such as compromised gastrointesitestinal absorption, or ineffective, such as significantly decreasing in bone mineral density (Rosen, 2013). Another treatment, teriparatide injection, is more expensive than other drugs and tends to be prescribed as sequential therapy with bisphosphates (Conwell et al, 2011; Rosen, 2013). Because our study sample includes only women newly diagnosed with osteoporosis, it is likely that physicians will initially prescribe the first-line oral osteoporosis medications we study rather than the injectable medications.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

“…Concerns have also been raised about the adverse effect of the donut hole on medication use (Zhang, Donohue, Newhouse, & Lave, 2009; Raebel, Delate, Ellis, & Bayliss, 2008; Fung et al, 2010; Hsu et al, 2008; Gu, Zeng, Patel, & Tripoli, 2010; Hales & George, 2010). Conwell et al (2011) found that once beneficiaries with partial or no gap coverage reached the gap they were more likely to discontinue osteoporosis medication use than beneficiaries with full gap coverage because of increased out-of-pocket (OOP) costs.…”

Section: Introductionmentioning

confidence: 99%

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Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Lin

Karaca‐Mandic

McCullough

et al. 2014

Women's Health Issues

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Background For women living with osteoporosis, high out-of-pocket drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis out-of-pocket medication costs and female Medicare beneficiaries’ initiation of osteoporosis drug therapy. Methods We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in standalone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the out-of-pocket costs and initiation of oral osteoporosis drug therapy during the year of diagnosis. Findings Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries’ out-of-pocket costs were not associated with the initiation of drug therapy for osteoporosis. However, there were statistically significant racial disparities in beneficiaries’ initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points respectively more likely to initiate drug therapy than whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries. Conclusions Access barriers for drug therapy initiation may be driven by factors other than patients’ out-of-pocket costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies.

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Section: Conclusion and Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Lin

Karaca‐Mandic

McCullough

et al. 2014

Women's Health Issues

View full text Add to dashboard Cite

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“…Conwell et al 19 used 2007 pharmacy claims data (n = 39,599) to examine the impact of the pre-2011 Part D coverage gap on changes in utilization of osteoporosis medications among postmenopausal female Medicare beneficiaries. They reported that over half of the sample reached the coverage gap.…”

Section: Resultsmentioning

confidence: 99%

“…The second and third studies reported that the coverage gap adversely affected medication adherence and persistence among beneficiaries taking drugs for osteoporosis. Using 2007 data (n = 39,599), Conwell et al 19 reported that postmenopausal female beneficiaries in either MAPDs or PDPs with a coverage gap were more likely to discontinue or skip osteoporosis medications than were beneficiaries in plans without a gap. Tamariz et al 23 used 2006 PDP data to examine persistence with selected treatments for chronic conditions—osteoporosis, rheumatoid arthritis, and multiple sclerosis—during the coverage gap.…”

Section: Resultsmentioning

confidence: 99%

“…29 Before the coverage gap is phased out (by 2020), providers should closely monitor CRN and drug discontinuation during the gap to avoid potential adverse clinical consequences, 22 especially in patients on osteoporosis treatments. 19,23 More aggressive interventions may be needed to emphasize switching medications to lower-cost but equally effective alternatives to alleviate the financial burden on beneficiaries. 22 Future research should examine why enrollees continue to employ cost-saving measures, 21 whether mail-order pharmacy use increases CRN, 26 and how CRN and nonpersistence affect health outcomes.…”

Section: Resultsmentioning

confidence: 99%

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Medicare Part D Research and Policy Highlights, 2012: Impact and Insights

Lau

Stubbings

2012

Clinical Therapeutics

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Background In the 6 years since the implementation of Medicare Part D in the United States, the program has been reported to improve quality, offer better beneficiary protections, and lower drug costs. Objective The purpose of this article was to highlight the latest key peer-reviewed research findings on Medicare Part D and major public policy initiatives for Part D for 2012. Methods PubMed was searched for studies on Medicare Part D published in 2011 in biomedical/scientific, peer-reviewed, English-language journals. For the policy update, sources included the Federal Register, the Medicare Prescription Drug Benefit Manual, the 2012 Final Call Letter, and guidance from the Centers for Medicare and Medicaid Services. Results Medicare Part D has been associated with increased medication utilization, reduced out-of-pocket expenditures, and an overall decrease in cost-related non-adherence and nonpersistence. Its impact on reduction in non-drug utilization of health services has been more apparent after the transition year in 2006 and among subsets of Medicare beneficiaries. Recent policy changes promise to make Part D more user-friendly, simplify choice, and offer greater protection to beneficiaries. The coverage gap will phase out by 2020. Both the quality rating system for prescription drug plans and medication therapy management programs were enhanced. Conclusions Although Part D was designed to improve drug benefits, improvements may be needed in plan selection and simplification, quality assessment (especially with regard to long-term impact and health outcomes), evidence-based improvements in medication therapy management, and disparities among priority subpopulations. Medicare Parts A, B, and D could be coordinated to offset costs by increasing medication expenses and decreasing expenses for nonprescription medical services, thereby improving the overall cost-effectiveness of the Medicare program.

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Medication adherence part two: Predictors of nonadherence and adherence

Wheeler

Roberts

Neiheisel

2014

Journal of the American Association of Nurse Practitioners

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Purpose This is the second of a three‐part series on medication adherence in which the authors describe the continuum of adherence to nonadherence of medication usage. Data sources Research articles through MEDLINE and PubMed. Conclusions Understanding the magnitude and scope of the problem of medication nonadherence is the first step in reaching better adherence rates (described in Part One of this series). The second step is to recognize the complexities of the reasons for medication adherence/nonadherence (described here). Reasons for nonadherence include beliefs related to the benefits of medication for physical and mental disorders, complexities of systems of health care and treatment plans, and lifestyle and demographic characteristics of patients. The final step is to evaluate each patient for medication adherence, tailoring the plan of care according to patient and system specific barriers (described in Part Three of this series). Implications for practice Nurse practitioners must recognize a critical element of thorough care is to assess medication adherence at each patient visit, countering patient and system barriers as indicated. Nurse practitioners also need to adjust assessment and prescribing practices according to the evidence for best practices to improve medication adherence.

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Out-of-Pocket Drug Costs and Drug Utilization Patterns of Postmenopausal Medicare Beneficiaries with Osteoporosis

Cited by 12 publications

References 22 publications

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Medicare Part D Research and Policy Highlights, 2012: Impact and Insights

Medication adherence part two: Predictors of nonadherence and adherence

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