High medication prices can create a financial burden for patients and reduce medication initiation. To improve decision making, public policy is supporting development of tools to provide real-time prescription drug prices. We reviewed the literature on medication cost conversations to characterize the context in which these tools may be used. Our review included 42 articles: a median of 84% of patients across four clinical specialties reported a desire for cost conversations ( n = 7 articles) but only 23% reported having held a cost conversation across six specialties ( n = 16 articles). Non-White and older patients were less likely to report having held a cost conversation than White and younger patients in 9 of 13 and 5 of 9 articles, respectively, examining these associations. Our review indicates that tools providing price information may not result in improved decision making without complementary interventions that increase the frequency of cost conversations with a focus on protected groups.
Through the lens of administrative burden and ordeals, we investigate challenges that low‐income families face in accessing health and human services critical for their children's healthy development. We employ a mixed methods approach—drawing on administrative data on economically disadvantaged children in Tennessee, publicly available data on resource allocations and expenditures, and data collected in purposive and randomly sampled interviews with public and nonprofit agencies across the state—to analyze the distribution of resources relative to children's needs and provide rich descriptions of the experiences of organizations striving to overcome administrative burdens and support families. We also scrutinize the place‐based resource deserts and environmental contexts of resource gaps and deficiencies in public policies governing the distribution of public resources that exacerbate administrative burdens and inequities in access to public resources. Our insights into the costs imposed on individuals and organizations and how they impede or spill over into other aspects of organizational work point to specific state and local program and policy changes that could be implemented to address resource constraints and alleviate burdens on organizations and poor families.
Background: Medications for opioid use disorder (MOUD) improve outcomes for pregnant women and infants. Our primary aim was to examine disparities in maternal MOUD receipt by family sociodemographic characteristics. Methods: This retrospective cohort study included mother-infant dyads with Medicaid-covered deliveries in Tennessee from 2009 to 2016. First, we examined family sociodemographic characteristicsincluding race/ethnicity, rurality, mother's primary language and education level, and whether paternity was recorded in birth recordsand newborn outcomes by type of maternal opioid use. Second, among pregnant women with OUD, we used logistic regression to measure disparities in receipt of MOUD by family sociodemographic characteristics including interactions between characteristics. Results: Our cohort from Medicaidcovered deliveries consisted of 314,965 mother-infant dyads, and 4.2 percent were exposed to opioids through maternal use. Among dyads with maternal OUD, MOUD receipt was associated with lower rates of preterm and very preterm birth. Logistic regression adjusted for family sociodemographic characteristics showed that pregnant women with OUD in rural versus urban areas (aOR: 0.66; 95% CI: 0.60-0.72) and who were aged !35 years versus 25 years (aOR: 0.75; 95% CI: 0.64-0.89) were less likely to have received MOUD. Families in which the mother's primary language was English (aOR: 2.47; 95% CI: 1.24-4.91) and paternity was recorded on the birth certificate (aOR: 1.30; 95% CI: 1.19-1.42) were more likely to have received MOUD. Regardless of high school degree attainment, non-Hispanic Black versus non-Hispanic White race was associated with lower likelihood of MOUD receipt. Hispanic race was associated with lower likelihood of MOUD receipt among women without a high school degree. Conclusions: Among a large cohort of pregnant women, we found disparities in receipt of MOUD among non-Hispanic Black, Hispanic, and rural pregnant women. As policymakers consider strategies to improve access to MOUD, they should consider targeted approaches to address these disparities.
Background Medication costs can lead to financial burdens for patients, creating barriers to effective medication use. Health care provider use of real‐time benefit tools (RTBTs) may facilitate cost conversations with patients. We sought to explicate patient views on how RTBTs could be used to improve cost considerations in prescribing decisions. Methods We conducted focus groups to characterize patient perspectives on holding cost conversations with their physicians and to identify factors that would influence the value of RTBTs. We focused on adults aged 50+ who reported trouble paying for their prescriptions. Three groups included patients with conditions requiring high‐cost treatments and one group included lower‐income patients independent of their medical conditions. Focus groups were recorded, transcribed, coded, and categorized to salient themes employing inductive and deductive approaches using the Health Equity Implementation Framework. Results Focus groups were conducted from 09/2020–12/2020 including 18 participants representing cancer (n = 6), diabetes (n = 6), rheumatoid arthritis (n = 3), and lower income (n = 3). Participants were between 50–74, eight self‐identified as Black, 10 as White, and eight reported earning <$50,000/year. We identified five themes regarding cost conversations (medication cost importance, past experiences with cost/cost conversations, perception of physician's role and knowledge, knowledge of existing resources, and influence on decision‐making) and four RTBT‐use‐specific themes (advantages/disadvantages, perceived relevance, data quality concerns, and implementation considerations). Conclusion Approaches that envision RTBTs as one‐size‐fits‐all technological interventions may underestimate the complexity of incorporating price information into prescribing decisions. Nevertheless, patients highlighted the potential value of accurate, real‐time information on medication costs to inform decision‐making.
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