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Counseling the Patient
Published in Harvey M. Rappaport, Kelly S. Straker, Tracy S. Hunter, Joseph F. Roy, The Guidebook for Patient Counseling, 2020
Harvey M. Rappaport, Kelly S. Straker, Tracy S. Hunter, Joseph F. Roy
Patient counseling is just one task among new responsibilities for therapy outcomes. No longer is it acceptable to fill valid prescriptions for less than optimal therapy. Patient counseling is expected to improve medication compliance, avoid medication errors, improve outcomes of medication therapy, and reduce overall medication costs.
Adherence and cost-effectiveness of subcutaneous immunotherapy and sublingual immunotherapy
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Dana V. Wallace, John Oppenheimer
In a recent U.S. study that examined reasons for nonadherence to SCIT, inadequate healthcare coverage by a third-party payor was the number one cause for discontinuation for 40% of the 213 patients who were not persistent [93]. In a literature review of 66 articles looking for the relationship between cost-sharing and adherence in multiple disease states, 85% showed that increasing the patient's share of medication costs significantly decreased adherence and negatively impacted disease outcome, irrespective of type of outcome measured or the disease state studied [94]. On average, for a $1 increase in the patient's copay, adherence decreases by 0.4% [94]. One study showed that an increase of $10 for diabetes medications could result in a 19% reduction in adherence [94]. Throughout the course of AIT, the patient will continue to assess if the results, present and future, are worth the out-of-pocket cost and inconvenience of continuing with AIT. It is likely that the cost of AIT in the United States is almost always an underlying consideration, whether deciding to initiate or to continue with AIT, even if other reasons are offered as the principal rationale for nonpersistence. While a zero copay would not provide 100% adherence, it is unfortunate that third-party payors fail to see that setting unreasonable patient cost for AIT, and thereby encouraging nonadherence, leads to ineffective treatment and worsening of the underlying disease, which can lead to further nonadherence.
The Problem of Rising Healthcare Costs and Spending
Published in Kant Patel, Mark Rushefsky, Healthcare Politics and Policy in America, 2019
Data suggest that price is, indeed, a major cost driver in the US. Here are some examples of prices of medical procedures in 2014 (Kamal and Cox 2018). An angioplasty cost over $78,000 in the US compared to about $34,000 in Switzerland. A cesarean-section birth costs, on average, over $16,000 in the US compared to just under $10,000 in Switzerland. An average MRI costs $1,119 in the US compared to $788 in Great Britain. The average price for an appendectomy in the US was nearly $16,000 compared to just over $8,000 in Great Britain. The average knee replacement surgery costs over $28,000 in the US compared to just over $20,000 in Great Britain. The average hip replacement surgery costs just over $29,000 in the US compared to over $19,000 in Australia. Looking at 2008 data, spending per capita on physician services was five times higher in the United States than the average of other industrialized countries (Ginsburg 2012). Medical tourism, discussed above, shows even wider spreads between the United States and other countries (Silver and Hyman 2018). A kidney transplant in the Philippines is one-sixth the cost of a transplant in the US. A hysterectomy in Thailand is one-eighth the cost in the United States. Silver and Hyman (2018) further note that the quality of care and expertise of providers is about as good as can be found in the US. We will consider the importance of medication costs below.
Pharmacological profile of once-weekly injectable semaglutide for chronic weight management
Published in Expert Review of Clinical Pharmacology, 2022
David C. W. Lau, Rachel L Batterham, Carel W. le Roux
HCPs should, however, be aware of several challenges associated with semaglutide treatment. Gastrointestinal side-effects are common, and HCPs should become familiar with strategies to mitigate these AEs by providing proper counseling to patients, especially during the dose up-titration period, as well as providing ongoing support for the full duration of semaglutide treatment. Semaglutide should be discontinued when non-responders are identified earlier on with treatment. Semaglutide is an injectable medication, and some patients may require counseling to overcome their fear of needles. High medication costs can be a barrier for some patients, which is especially true for the vulnerable population of patients without health insurance plans and access to medications. The pharmacoeconomics and cost-effectiveness of semaglutide 2.4 mg treatment has not been established and raises the question of whether obesity pharmacotherapy can be justified.
A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools
Published in Journal of Asthma, 2022
Lucy C. Holmes, Heather Orom, Heather K. Lehman, Stacie Lampkin, Jill S. Halterman, Vanessa Akiki, Alicia A. Supernault-Sarker, Susan B. Butler, Denise Piechowski, Patricia M. Sorrentino, Ziqiang Chen, Gregory E. Wilding
Medication costs were covered by the student’s medical insurance, and transported from the pharmacy to the school by the research coordinator. Most students were prescribed fluticasone propionate MDI (Flovent) or fluticasone proprionate and salmeterol xinafoate MDI (Advair). We received an Investigational New Drug exemption from the FDA to use Advair HFA in students ages 4–11 years. If the student’s health insurance formulary required another drug in the same category to be used, then this was prescribed instead, at equivalent dosing for the indicated step therapy. Prior authorizations were submitted as needed to dispense two controllers at a time for each student, one for home and one for school. Students whose insurance company declined the prior authorizations were provided with sample medications.
Demystifying pharmaceutical patient assistance programs
Published in Journal of Dermatological Treatment, 2022
Erin K. Collier, Kyla N. Price, Jennifer L. Hsiao, Vivian Y. Shi
For patients who do not qualify for pharmaceutical-based PAPs, other available programs may be able to assist with prescription drug coverage. For example, independent charity organizations, such as the Patient Access Network (PAN) Foundation and the HealthWell Foundation, offer monetary assistance for medication costs (19). These programs are especially useful for insured patients, including those with Medicare, and for coverage of expensive dermatologic drugs, such as guselkumab (Tremfya™) and risankizumab (Skyrizi™) (19,20). Coupons that offer discounts on the cash price of medications can also be considered for those patients with limited or no insurance coverage. In addition to those provided by manufacturers and pharmaceutical representatives, patients can be directed to online databases (such as goodrx.com (21)) that provide a list of coupons for specific retail pharmacies. Moreover, physicians can send prescriptions to online specialty pharmacies (such as dermrxpharmacy.com (22)), which can assist with coverage research and search for the lowest possible out-of-pocket price for dermatologic drugs. Finally, provision of free in-office samples can be considered for those patients with financial hardship requiring only infrequent medication dosages, such as with the every 12-week maintenance administration of biologics like risankizumab (SkyriziTM) and ustekinumab (Stelara®).