The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS

Zamani-Hank, Yasamean

doi:10.1089/pop.2015.0076

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…Additionally, while diversion in context of a peer network may have positive social effects (eg increased social capital or cohesion) that support adherence, diversion in an impersonal commercial market through illicit pill brokers likely would not have such effects. Finally, in a context like the U.S. where cost is a significant barrier to HIV treatment access, 57 it may be more difficult to replace shared pills-leading to greater likelihood of a negative impact of sharing on treatment adherence-than in a setting like South Africa where ART is available at clinics free of charge.…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success

Rock

Comins

Mulumba

et al. 2022

J Int Assoc Provid AIDS Care

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In South Africa, 62% of female sex workers (FSW) are estimated to be living with HIV. Qualitative research indicates that FSW share antiretroviral therapy (ART) with peers to surmount treatment barriers. We quantitatively described ART sharing, its correlates, and its relationship with viral suppression (VS) among FSW living with HIV in eThekwini, South Africa. Among FSW on ART (n = 890), 30% ever shared (gave and/or received) ART. Sharing ART was more likely among those with higher levels of alcohol use, illicit drug use, depression severity, and physical/sexual violence in the adjusted model. There was a positive, dose-response relationship between number of pills given to peers in the last 30 days and VS likelihood (aPR: 1.05, 95% CI: 1.02, 1.08; p < 0.01). Giving pills may strengthen peer relationships, which may facilitate ART adherence. ART distribution through peer networks holds promise as a context-appropriate intervention for improving ART adherence among FSW in this setting.

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Section: Discussionmentioning

confidence: 99%

Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success

Rock

Comins

Mulumba

et al. 2022

J Int Assoc Provid AIDS Care

View full text Add to dashboard Cite

show abstract

“…The United States has the highest antiretroviral treatment (ART) prices yet the lowest rate of HIV viral suppression (54%) compared with all other well-resourced countries, including Britain, Australia, and Canada . High ART costs are among many structural barriers that lead to poor treatment access and adherence, contributing to suboptimal HIV outcomes in the United States . We sought to characterize costs of recommended initial ART regimens in the United States from 2012 to 2018 and the magnitude of cost changes over time.…”

mentioning

confidence: 99%

HIV Antiretroviral Therapy Costs in the United States, 2012-2018

et al. 2020

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In this issue of JAMA Internal Medicine, Feldman and colleagues 1 report that Medicare spending on insulin for patients with diabetes was an estimated $7.8 billion, which is $4.4 billion more than the Centers for Medicare & Medicaid Services might have spent by using the prices negotiated by the US Department of Veterans Affairs and their formulary restrictions. Even if the $4.4 billion figure overestimates the potential savings, the potential for lower prices would substantially increase many patients' access to life-saving insulin products. The report by Feldman et al 1 is one of several studies that JAMA Internal Medicine has recently published illustrating the opportunities for savings of billions of dollars annually in the Medicare Part D prescription drug program. For the top 50 oral drugs dispensed based on Medicare spending, Venker et al 2 estimated that by using US Department of Veterans Affairs medication prices, Medicare could have saved up to $14.4 billion in 2016 of the estimated $32.5 billion spent. For angiotensin-converting enzyme inhibitors and angiotensin-II-receptor blockers alone, Growdon et al 3 estimated potential Medicare savings in 2016 and 2017 at $676 million of the total $754 million spent by using generic substitution and therapeutic interchange. For inhaler prescriptions, Feldman et al 4 previously estimated potential Medicare savings in 2017 of up to $4.2 billion of the $7.3 billion spent through use of negotiated prices and a defined formulary. These studies have a consistent and clear message. At present, the issue for the federal government is not the ability to easily save billions of dollars each year in Medicare Part D spending. Rather, the issue is the political will in Washington, DC, to facilitate savings through legislation and regulatory changes, such as measures that would allow price negotiations, benchmark pricing, and formulary restrictions, and in states to remove prescribing barriers, such as those for generic substitution and therapeutic interchange.

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“…Importantly, in this era of increasing consciousness of health care costs, familiarity with the costeffectiveness of various therapeutic strategies is increasingly important not just for payers, institutions, and physicians, but for patients as well, as out-of-pocket payments and deductibles are increasingly significant. 32,33 As there is no definitive consensus on optimal strategies for preventing FS, nor an agreement that using a graft is necessary, our primary objectives included evaluating whether any incremental cost-effectiveness of using these two widespread methods were below WTP thresholds, and thus appropriate for usage. Our decision tree looked at this parameter at 1-to 4-year follow-up, and we noted that the FFG had ICER below most acceptable WTP thresholds versus acellular dermis, which was above the threshold and thus not recommended.…”

Section: Discussionmentioning

confidence: 99%

Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

et al. 2018

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A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of grafting techniques used to prevent Frey Syndrome. The authors performed a sensitivity analysis to calculate what the probability of preventing Frey Syndrome would have to be and maximum costs associated with using grafting techniques to warrant their use as more "cost-effective" choice than using neither. Decision pathways utilized were uses of (1) free fat graft (FFG), (2) acellular dermis, and (3) no grafting. The probability of developing Frey syndrome and costs were extracted from previous studies to construct the decision tree. The primary effectiveness was the ICER of FFG or acellular dermis to prevent Frey syndrome. The initial outcomes included preventing Frey syndrome (effectiveness = 1) or developing Frey syndrome (effectiveness = 0). Compared with not using a graft, the ICER of using FFG and acellular dermis were $10,628 and $50,813, respectively. Frey syndrome was found in 2.6% of patients postoperatively in FFG group, 9.8% of patients in acellular dermis group, and 30.7% of patients who did not have a graft. The ICER shows absolute dominance of FFG with lower cost and high effectiveness over acellular dermis. This economic evaluation strongly supports the use of FFG over acellular dermis as cost-effective approach for prevention of postparotidectomy Frey syndrome.

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The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS

Cited by 9 publications

References 17 publications

Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success

Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success

HIV Antiretroviral Therapy Costs in the United States, 2012-2018

Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

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