Benefit Design And Specialty Drug Use

Goldman, Dana P.; Joyce, Geoffrey F.; Lawless, Grant; Crown, William H.; Willey, Vincent J.

doi:10.1377/hlthaff.25.5.1319

Cited by 101 publications

(93 citation statements)

References 6 publications

(3 reference statements)

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“…[3][4][5][6] GH is an example of the fastest growing class of pharmaceuticals: expensive biological specialty drugs, many with controversial indications and unclear end points for treating chronic conditions. [6][7][8][9][10] This study addresses current gaps in the literature by systematically investigating endocrinologists' recommendations for GH treatment of ISS, and assesses (1) the relative influence of guidelines, patient preferences, and physician beliefs on recommendations to initiate GH, and (2) the determinants of physician decisions to continue GH unchanged, intensify GH (increase mg/kg dose), or terminate GH in children after a course of treatment, including the roles of treatment response, family wishes, pretreatment factors, attitudes, and contextual factors.…”

mentioning

confidence: 99%

A National Study of Physician Recommendations to Initiate and Discontinue Growth Hormone for Short Stature

Silvers

Marinova

Mercer³

et al. 2010

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Almost 500 000 US children are potential candidates for GH therapy. Overall use of GH for ISS depends on physician decisions to both initiate and continue treatment. However, the determinants of both critical decisions are not known. WHAT THIS STUDY ADDS:This is the first study to examine physician recommendations for both initiation and continuation of a treatment. The data underscore powerful nonphysiologic influences (including physician attitudes and previous decisions, and family preferences) that underlie variation in decisions and drive GH use. abstract OBJECTIVES: Overall growth hormone (GH) use depends on decisions to both initiate treatment and continue treatment. The determinants of both are unclear. We studied how physicians decided to begin GH in idiopathic short stature and how, after an initial course of treatment, they decided to continue, intensify (increase the dose), or terminate treatment. METHODS:We used a national census study of 727 pediatric endocrinologists involving a structured questionnaires with a factorial experimental design. Main outcome measures were GH recommendations for previously untreated children and those children who were treated with GH for 1 year. RESULTS: The response rate was 90%. In previously untreated children, recommendations to initiate GH were consistent with guidelines and also influenced by family preferences and physician attitudes (P Ͻ .001). In children treated with GH, recommendations on whether to continue GH were influenced by the growth response to therapy (P Ͻ .01) but were divided regarding course of action. With identical growth responses to treatment, physician decisions diverged (intensify versus discontinue GH) and were driven by independent, nonphysiologic, and contextual factors (eg, physician attitudes, family preferences, and GH-initiation recommendation; each P Ͻ .001). Together, attitudinal and contextual factors exerted more influence on continuation decisions than did the growth response to therapy. CONCLUSIONS: Physician decisions to initiate GH are largely consistent with evidence-based medicine. However, decisions about continuing GH vary and are strongly influenced by factors other than response to treatment. With a potential market of 500 000 US children and costs exceeding $10 billion per year, changes in GH use may depend on potentially modifiable physician attitudes and family preferences as much as physiologic evidence.

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mentioning

confidence: 99%

A National Study of Physician Recommendations to Initiate and Discontinue Growth Hormone for Short Stature

Silvers

Marinova

Mercer³

et al. 2010

Pediatrics

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“…Multi-tiered plans are the standard in the United States (Goldman 2006), with 89% of covered workers in 2010 belonging to a plan with a tiered cost-sharing formula for prescription drugs (Kaiser Family Foundation 2012). In contrast, only 19% of Canadian employees with drug benefit plans appear to have managed formularies, suggesting this might be a major opportunity for reducing private sector drug costs, again without limiting patients' access to medicines.…”

Section: Discussionmentioning

confidence: 99%

“…Specialty drugs are becoming increasingly popular, including some that can cost hundreds of thousands of dollars every year (Goldman 2006;Kim et al 2011). If this trend continues, it is likely that many Canadians, including those with chronic conditions, will hit these benefits limits.…”

Section: Discussionmentioning

confidence: 99%

Cost-Control Mechanisms in Canadian Private Drug Plans

Kratzer¹,

McGrail²,

Strumpf³

et al. 2013

hcpol

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Approximately 68% of Canadians receive prescription drug coverage through an employersponsored private plan. However, we have very limited data on the structure of these plans. This study aims to identify and describe the use of cost-control mechanisms in private drug plans in Canada and describe what private coverage looks like for the average Canadian.Using 2010 data from over 113,000 different private drug plans, provided by Applied Management Consultants, we determined the overall use of key cost-control measures, and

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“…This is evidenced by the elasticities (percentage change in use associated with a 1% increase in effective coinsurance rates) of specialty drug use by patients among 4 conditions: rheumatoid arthritis, kidney disease, multiple sclerosis, and cancer. For example, Goldman et al 19 reported that if an insurance plan were to double the cost of sharing for rheumatoid arthritis specialty drugs, overall spending on these drugs would decrease by 21%. However, for cancer drugs, spending would be decreased by only 1%.…”

Section: Why Are Cancer Drugs So Expensive?mentioning

confidence: 99%