The association between cost sharing, prior authorization, and specialty drug utilization: A systematic review

Ismail, Wesam W; Witry, Matthew J.; Urmie, Julie M.

doi:10.18553/jmcp.2023.29.5.449

Cited by 11 publications

(14 citation statements)

References 52 publications

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“…Although more recent data show improvement in prescribing rates to 70% in this population, just 40% persist on an ACEI or angiotensin receptor blocker for at least 90 days (Nicholas et al, 2023). These data illustrate gaps in both prescribing kidney protective medication and continuity of care over time, potentially related to cost, lack of patient education, polypharmacy and adverse effects (Ismail et al, 2023).…”

Section: Gaps Between Knowledge and Implementation In Kidney Carementioning

confidence: 97%

“…Electronic health records, reminders, team-based nudges and decision support tools offer a promising support for quality kidney care in busy clinical practices (Peralta et al, 2020). The extra time and effort spent negotiating preauthorizations or completing medication assistance programme requests, along with the need for frequent monitoring of multiple medications, however, also hinder appropriate prescribing (Ismail et al, 2023). Many primary care practitioners have only a few minutes allocated per patient because of institutional pressure or patient volume.…”

Section: Challenges For Clinical Inertiamentioning

confidence: 99%

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Mind the gap in kidney care: Translating what we know into what we do

Luyckx,

Tuttle,

Abdellatif

et al. 2024

Journal of Renal Care

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Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

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Section: Gaps Between Knowledge and Implementation In Kidney Carementioning

confidence: 97%

Section: Challenges For Clinical Inertiamentioning

confidence: 99%

Mind the gap in kidney care: Translating what we know into what we do

Luyckx,

Tuttle,

Abdellatif

et al. 2024

Journal of Renal Care

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show abstract

“…Clinicians everywhere are working under time-pressure imposed by cost-efficiency demands and large patient numbers. In addition, in some settings, extra time is required for negotiation of pre-authorizations or requests for medication assistance which delay or hinder appropriate prescribing [94].…”

Section: Health Care Professionalsmentioning

confidence: 99%

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Luyckx,

Elmaghrabi,

Sahay

et al. 2023

Am J Nephrol

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Background: Chronic kidney disease (CKD) is an important but insufficiently recognized public health problem. Unprecedented advances in delaying progression of CKD and reducing kidney failure and death have been made in recent years, with the addition of the sodium glucose co-transporter 2 inhibitors and other newer medication to the established standard of care with inhibitors of the renin angiotensin system. Despite knowledge of these effective therapies, their prescription and use remains suboptimal globally, and more specially in low resource settings. Many challenges contribute to this gap between knowledge and translation into clinical care, which is even wider in lower resource settings across the globe. Implementation of guideline-directed care is hampered by lack of disease awareness, late or missed diagnosis, clinical inertia, poor quality care, cost of therapy, systemic biases, and lack of patient empowerment. All of these are exacerbated by the social determinants of health and global inequities. Summary CKD is a highly manageable condition but requires equitable and sustainable access to quality care supported by health policies, health financing, patient and healthcare worker education and affordability of medications and diagnostics. Key Messages The gap between the knowledge and tools to treat CKD and the implementation of optimal quality kidney care should no longer be tolerated. Advocacy, research and action are required to improve equitable access to sustainable quality care for CKD everywhere.

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“…To date, while there are several studies investigating the relationship between cost sharing and drug utilization 15 , 16 , there have been few studies examining whether medical policies or health insurance systems contribute to alleviating economic disparities in drug utilization. Furthermore, few studies have evaluated the impact of medical policies or health insurance systems on the treatment patterns of patients with moderate-to-severe psoriasis.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, few studies have evaluated the impact of medical policies or health insurance systems on the treatment patterns of patients with moderate-to-severe psoriasis. Moreover, the limited studies conducted on psoriasis are predominantly from Western countries, and there is a scarcity of research conducted in Asian 15 . In this study, we aimed to examine the impact of RCP on the accessibility of biologics in patients with moderate-to-severe psoriasis according to their income levels.…”

Section: Introductionmentioning

confidence: 99%

Reduced economic disparity in biologics use for psoriasis after introducing the reducing copayment program

Jung,

Kim,

Cho

et al. 2024

Sci Rep

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Biologics for psoriasis are efficient and safe, but very expensive. We investigated the association of the reducing copayment program (RCP) with changes in biologics use patterns depending on the income levels of patients with moderate-to-severe psoriasis. This nationwide cohort study included patients identified as having moderate-to-severe psoriasis between 2014 and 2020. Logistic regression models were used to estimate the odds ratio for the use of biologics according to income levels. Among 57,139 patients with moderate-to-severe psoriasis, 3464 (6.1%) used biologics for psoriasis from 2014 to 2020. After the introduction of RCP in 2017, the proportion of patients with moderate-to-severe psoriasis using biologics rapidly increased from 5.0% in 2016 to 19.2% in 2020; the increase was more remarkable in patients with the lowest or mid-low income compared to those with Medical Aid. Drug survival of biologics was higher in patients with the highest income before the RCP, but became comparable between those with high and low incomes after RCP introduction. The introduction of RCP was associated with an increased use of biologics in patients with moderate-to-severe psoriasis of all income levels; however, the effect was more pronounced in low-income patients. The RCP may contribute to alleviating the disparity in access to biologics.

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The association between cost sharing, prior authorization, and specialty drug utilization: A systematic review

Cited by 11 publications

References 52 publications

Mind the gap in kidney care: Translating what we know into what we do

Mind the gap in kidney care: Translating what we know into what we do

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Reduced economic disparity in biologics use for psoriasis after introducing the reducing copayment program

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