Projections of US Prescription Drug Spending and Key Policy Implications

Conti, Rena M.; Turner, Ani; Hughes-Cromwick, Paul

doi:10.1001/jamahealthforum.2020.1613

Cited by 9 publications

(5 citation statements)

References 4 publications

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“…As with many electronic health record (EHR)-based and other tools, there are important implementation considerations that influence the success of RTBTs in practice. 2 In this issue of the journal, Desai et al 3 present findings from a cluster randomized evaluation of one institution's experience with RTBTs. They found that RTBTs could be used for a small minority (4%) of prescription orders and their use was associated with an 11% reduction in out-of-pocket costs when prescribers were shown lowercost choices via the EHR.…”

Section: Role Of the Funder/sponsormentioning

confidence: 99%

“…Rising drug costs are placing more financial burden on patients . High out-of-pocket costs contribute to decreased medication adherence, poor health outcomes, and higher overall health care spending .…”

Section: Introductionmentioning

confidence: 99%

“…ising drug costs are placing more financial burden on patients. [1][2][3] High out-of-pocket costs contribute to decreased medication adherence, poor health outcomes, and higher overall health care spending. [4][5][6][7][8][9] In many cases, patients could save if they used a mail-order pharmacy, received a longer days' supply, or were prescribed another clinically appropriate medication.…”

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confidence: 99%

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Effects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs

Desai

Chen²,

Wang

et al. 2022

JAMA Intern Med

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ImportanceRising drug costs contribute to medication nonadherence and adverse health outcomes. Real-time prescription benefit (RTPB) systems present prescribers with patient-specific out-of-pocket cost estimates and recommend lower-cost, clinically appropriate alternatives at the point of prescribing.ObjectiveTo investigate whether RTPB recommendations lead to reduced patient out-of-pocket costs for medications.Design, Setting, and ParticipantsIn this cluster randomized trial, medical practices in a large, urban academic health system were randomly assigned to RTPB recommendations from January 13 to July 31, 2021. Participants were adult patients receiving outpatient prescriptions during the study period. The analysis was limited to prescriptions for which RTPB could recommend an available alternative. Electronic health record data were used to analyze the intervention’s effects on prescribing. Data analyses were performed from August 20, 2021, to June 8, 2022.InterventionsWhen a prescription was initiated in the electronic health record, the RTPB system recommended available lower-cost, clinically appropriate alternatives for a different medication, length of prescription, and/or choice of pharmacy. The prescriber could select either the initiated order or one of the recommended options.Main Outcomes and MeasuresPatient out-of-pocket cost for a prescription. Secondary outcomes were whether a mail-order prescription and a 90-day supply were ordered.ResultsOf 867 757 outpatient prescriptions at randomized practices, 36 419 (4.2%) met the inclusion criteria of having an available alternative. Out-of-pocket costs were $39.90 for a 30-day supply in the intervention group and $67.80 for a 30-day supply in the control group. The intervention led to an adjusted 11.2%; (95% CI, −15.7% to −6.4%) reduction in out-of-pocket costs. Mail-order pharmacy use was 9.6% and 7.6% in the intervention and control groups, respectively (adjusted 1.9 percentage point increase; 95% CI, 0.9 to 3.0). Rates of 90-day supply were not different. In high-cost drug classes, the intervention reduced out-of-pocket costs by 38.9%; 95% CI, −47.6% to −28.7%.Conclusions and RelevanceThis cluster randomized clinical trial showed that RTPB recommendations led to lower patient out-of-pocket costs, with the largest savings occurring for high-cost medications. However, RTPB recommendations were made for only a small percentage of prescriptions.Trial RegistrationClinicalTrials.gov Identifier: NCT04940988; American Economic Association Registry: AEARCTR-0006909

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Section: Role Of the Funder/sponsormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs

Desai

Chen²,

Wang

et al. 2022

JAMA Intern Med

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“…Nonretail drugs—those administered in medical settings rather than used at home—accounted for about one-third of US prescription drug spending in 2018. 1 Costs for these drugs are projected to increase faster than retail drugs. 2 The majority of cancer drugs are delivered in health care settings.…”

Section: Introductionmentioning

confidence: 99%

Association Between New 340B Program Participation and Commercial Insurance Spending on Outpatient Biologic Oncology Drugs

et al. 2023

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ImportancePrevious studies have found that hospitals participating in the 340B Drug Pricing Program have higher Medicare Part B spending and expansion into affluent neighborhoods. Less is known about the association of 340B participation with spending by commercial insurance, where reimbursements are higher than Medicare.ObjectiveTo use the Affordable Care Act expansion of eligibility for the 340B Drug Pricing Program to study the association between participation and spending on outpatient-administered oncological drugs for commercially insured patients.Design, Setting, and ParticipantsThis cohort study included a balanced panel hospital cohort containing new and never 340B program participants between 2007 and 2019; more recent data were not included to avoid the effect of disruptions in care due to the COVID-19 pandemic. Descriptive analyses documented spending trends for patients receiving common outpatient-administered biologics used in cancer treatments (bevacizumab, filgrastim, pegfilgrastim, rituximab, and trastuzumab) at 340B (treated) and non-340B (control) hospitals. A difference-in-differences model assessed changes in episode drug spending. Analyses were conducted between December 2021 and June 2022.ExposureNew 340B program participation between 2010 and 2016.Main Outcome and MeasuresTotal drug episode spending, with control variables including total billed units, drug, calendar-year fixed effects, and hospital fixed effects.ResultsOf 95 127 included episodes (56 917 [59.8%] episodes in female patients) across 478 hospitals, patients seen in 340B and non-340B hospitals were similar in sex and drug used, and 340B hospital patients were older than non-340B patients (median [IQR] age for all patients, 61 [51-71] years). New 340B participating hospitals were more likely to be small (&lt;50 beds) and more likely to be in rural settings. In the difference-in-differences analysis, total episode drug spending increased by $4074.69 (95% CI, $1592.84-$6556.70; P = .001) in the year following start of 340B program participation relative to nonparticipants. Heterogeneous group time effects were seen, with earlier participants less likely to have increased episode spending.Conclusions and RelevanceIn this cohort study, new 340B participation was associated with statistically significant higher oncological drug episode spending compared with nonparticipants after changes in 340B inclusion rules in 2010. These findings raise questions about unintended consequences of the 340B program on drug spending from the commercially insured population.

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“…Pharmaceutical expenditures, which account for approximately one-sixth of the total health expenditures in developed countries (Organization for Economic Co-operation and Development [OECD], 2021), are one of the most important expense items of the Social Security Institution in Turkey (Çalışma ve Sosyal Güvenlik Bakanlığı [ÇSGB], 2021). It has been reported that pharmaceutical expenditures have increased significantly over the last decade, mainly due to expenditures on prescription drugs, increased use, and the introduction of new and costly drugs (Conti et al, 2021;DeMartino et al, 2021). For this reason, countries should control pharmaceutical expenditures and take the necessary precautions.…”

Section: Introductionmentioning

confidence: 99%

A General Evaluation of the Reasons for Medication Wastage: A University Hospital Example

Aslan¹,

Demir²

2023

SHYD

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Aim:In this study, it was aimed to evaluate the medication wastage and associated factors in a university hospital and to reveal the economic dimension of medication wastage. Method:The population of this descriptive study consisted of 834 medications that were wasted in a university hospital in Istanbul. Sample selection was not made in the study and the entire population was taken into consideration. The data were collected using Medication Wastage Forms and Medication Wastage Reports recorded by the Pharmacy Department. Descriptive statistics (frequency, percentage) were used in the analysis of the data. The World Health Organization Anatomical Therapeutic Chemical (ATC) Classification System was used to classify wasted medications. Results:The study results showed that medication wastage has been mostly caused by preparation-related reasons, treatment changes, and adverse drug reactions. It was determined that the wastage rate was higher in pediatric hematology, chemotherapy, and adult hematology units. It was determined that the total cost of medication wastage was 98,950.12 ₺ and 66.98% of this cost was preventable. According to the Anatomical, Therapeutic and Chemical (ATC) Classification System, 33.81% of the wasted medication was classified as antineoplastic and immunomodulating agents. Conclusion:In this study, it was determined that the amount and cost of medication wastage in the hospital were at a serious level. It was determined that wastage predominantly occurred in units with high-risk patient groups and that a large part of it was preventable. Hospital management needs to focus on preventable causes of waste in terms of the effective use of resources.

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Projections of US Prescription Drug Spending and Key Policy Implications

Cited by 9 publications

References 4 publications

Effects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs

Effects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs

Association Between New 340B Program Participation and Commercial Insurance Spending on Outpatient Biologic Oncology Drugs

A General Evaluation of the Reasons for Medication Wastage: A University Hospital Example

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