Statins are commonly used for treating the elevation of lipids in the blood stream, also known as hyperlipidemia. Statins are considered to be an economical and effective way to achieve desirable long-term health outcomes for hyperlipdemic patients, however, ensuring adequate adherence to statin medications is often difficult as hyperlipidemia is an asymptomatic condition and patients sometimes fail to recognize the importance of being adherent to their statin medications. The purpose of this study was to evaluate impact of enrollment under Medicaid and Medicare Part D and patient out-of-pocket costs on patient statin adherence, persistence, and mean number of gap days per claim. A retrospective claims database was used in this study to conduct repeated measures analyses on statin prescription claims from independent community pharmacies in Texas. The pre-period in this study extended from January 1, 2005 to September 30, 2005 (Medicaid period) and the post-period extended from January 1, 2006 to September 30, 2006 (Medicare period). The study population consisted of dual-eligible beneficiaries in Texas who had at least two stain claims in the pre and post-periods each. The final study population comprised of 1734 Texas dual-eligible beneficiaries with 6064 statin claims during the pre-period and 7956 claims during the post-period. Patients had an average of 3.49 statin claims during the pre-period and 4.58 statin claims during the post-period. Patients were dispensed an average of 57.34 days of drug supply per claim during the pre-period and 42.02 days of drug supply per claim during the post-period. The results from this study showed that out-of-pocket costs for patients increased from $0.39 per claim under Medicaid to $13.36 per claim under Medicare Part D. Patient adherence to statins was assessed by calculating medication possession ratio (MPR). The results showed that mean patient MPR increased from 75.71 percent under Medicaid to 79.37 percent under Medicare. Results from generalized estimating equations showed that odds of being adherent (i.e., MPR ≥ 80 percent) to statins increased by 36 percent when patients were covered under Medicare Part D. Linear mixed model analysis showed that MPR increased by 3.66 percent when patients were covered under Medicare Part D compared to Medicaid. Also, patient MPR was found to increase by 0.13 percent when patient out-of-pocket payment increased by $1.00. Patient persistence was calculated by measuring gaps in therapy and patients with a gap of 60 or more days were considered to have discontinued therapy. Patients were found to be persistent to their drug therapy for an average of 151.76 days under Medicaid and 159.75 days under Medicare. Linear mixed model analysis showed that patient persistence increased by 7.99 days when patients were enrolled under Medicare Part D compared to Medicaid. Days of persistence was also found to increase by 0.41 days when patient out-of-pocket costs increased by $1.00. Mean number of gap days per claim during the Medicaid period was 11.91 days and decreased to 8.38 days during the Medicare period. Linear mixed model analysis showed that mean number of gap days per claim decreased by 3.52 days when patients were enrolled under Medicare Part D compared to Medicaid. Mean number of gap days in therapy were found to decrease by 0.10 days when patient out-of-pocket costs increased by $1.00. The results of this study showed that implementation of Medicare Part D resulted in an increase in MPR and persistence and a decrease in mean number of gap days per claim for Texas dual-eligible beneficiaries. The results also suggest that increased out-of-pocket costs under Medicare Part D may not have had a negative impact on statin drug utilization by dual-eligible beneficiaries in Texas. / text

No description available.

The present study is a retrospective cohort analysis which sought to examine adherence to medications used in managing painful diabetic peripheral neuropathy (PDPN) and to determine their association with oral antidiabetic (OAD) medication adherence using the Texas Medicaid prescription claims database. The study objectives were to: 1) provide a description of PDPN and OAD medication use among the study subjects; 2) determine if PDPN medication adherence differs among individual PDPN agents (i.e., tricyclic antidepressants, gabapentin, pregabalin and duloxetine); 3) determine if pre-index OAD and post-index OAD medication adherence differs among mono, dual, and triple OAD therapies; and 4) determine if PDPN medication adherence is related to post-index OAD medication adherence while controlling for covariates. Study participants were adult (≥18 years) Medicaid beneficiaries prescribed OAD and PDPN medications. The index date was the first PDPN prescription. Data were extracted from June 1, 2003 to October 31, 2009 and prescription claims were analyzed over an 18-month study period (i.e., 6 months pre-index and 12 months post index period). Medication possession ratio (MPR) was used as a proxy measure of medication adherence. An MPR less than 80 percent was regarded as being non-adherent to prescribed medication, while an MPR greater than or equal to 80 percent was regarded as being adherent to prescribed medication. Objective 1 was addressed using descriptive statistics (i.e., mean, standard deviation, frequency). Univariate analysis (ANOVA) was employed to address Objectives 2 and 3. Multivariate analyses (i.e., multiple linear regression and logistic regression) were conducted to address Objective 4. For the logistic regression MPR was dichotomized at the cut-off value of 80 percent. A total of 4,277 patients met the study’s inclusion criteria. The overall mean MPR (±SD) for PDPN medications was 75.4 percent (±23.9). Mean MPR (±SD) was highest for duloxetine (85.6% ±18.2) and was lowest for pregabalin (69.4% ±24.9). Mean MPR differed significantly among individual PDPN medications (p<0.0001). The overall mean MPR (±SD) for OAD medications in the pre and post-index period was 73.0 percent (±24.3) and 64.5 percent (±25.6) respectively. In both pre and post-index periods, mean MPR differed significantly among mono, dual, and triple OAD therapies (p<0.0001). In the pre-index period, mean MPR (±SD) was highest for monotherapy users (75.4% ±24.7) and was lowest for triple therapy users (63.9% ±22.9). Similarly, mean MPR (±SD) was highest for monotherapy users (69.0% ±26.1) and was lowest for triple therapy users (52.9% ±21.8) in the post-index period. After controlling for the covariates, PDPN adherence (i.e., MPR) was statistically significant (p<0.0001) and positively related to post-index OAD adherence (i.e., MPR). PDPN patients who were non-adherent (i.e., MPR<80%) to their PDPN medications (or neuropathic pain medications), compared to those who were adherent (MPR≥80%), were significantly less likely to be adherent to their OAD medications [Odds Ratio (OR) = 0.626, 95% CI=0.545-0.719]. In addition, post-index OAD adherence (i.e., MPR) did not differ significantly (p>0.05) when pregabalin, duloxetine and gabapentin users were individually compared to tricyclic antidepressants users. In conclusion, PDPN patients who were adherent (i.e., MPR≥80%) to their PDPN medications, compared to those who were not adherent (i.e., MPR<80%), were more adherent to their OAD medications. Also, adherence to OAD medications was independent of the type of PDPN medication used. PDPN patients need to be educated regularly that neuropathic pain medications only relieve the pain associated with the neuropathy but achieving adequate glycemic control remains the only established approach for slowing down the progression of the neuropathy and other complications associated with the diabetes. / text

INTRODUCTION: Medicare Part D provides prescription drug coverage to seniors through a benefit plan with a major deductible inserted in the middle. It is important to study the extent to which this structure affects seniors’ adherence to prescription medications. Therefore, this study had the following objectives: (1) To identify characteristics of beneficiaries reaching and not reaching the coverage gap, (2) To study the entry and exit times from the coverage gap, (3) To study the impact of a complete gap in coverage on beneficiaries’ adherence to prescription medications, (4) To study the impact of a partial gap in coverage on beneficiaries’ adherence to prescription medications METHODS: This was a retrospective quasi-experimental analysis with matched control groups using a nationally representative sample of Part D enrollees from 2008 Centers for Medicare and Medicaid (CMS) datasets. Adherence to each oral medication taken for one or more of the seven pre-defined therapeutic classes before and after reaching the coverage gap was measured using the Medication Possession Ratio (MPR). Appropriate statistical tests for significance were performed for each analysis RESULTS: A quarter of our sample (24.42%) reached the coverage gap in 2008. Most of the beneficiaries reaching the coverage gap did so by end of September. Those reaching the coverage gap and losing all coverage experienced significantly greater reductions in adherence (3% more for beta-blockers to 9% more for oral anti-diabetic agents), compared to those not reaching the coverage gap. A considerable proportion of beneficiaries stopped taking medications in both the groups and the proportion of beneficiaries considered adherent also dropped in both the groups during the coverage gap period. CONCLUSIONS: Medicare Part D beneficiaries face significant barriers to adherence and this is especially highlighted among those reaching the coverage gap. Interventions to improve adherence in this group should target all beneficiaries, especially those with several chronic conditions.

No description available.

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Background: Shifting the healthcare payment system from a volume-based to a value-based model has been a significant effort to improve the quality of care and reduce healthcare costs in the US. In 2018, Massachusetts Medicaid launched Accountable Care Organizations (ACOs) as part of the effort. Constructing, assessing, and risk-adjusting quality measures are integral parts of the reform process. Methods: Using data from the MassHealth Data Warehouse (2016-2019), we assessed the loss of community tenure (CTloss) as a potential quality measure for patients with bipolar, schizophrenia, or other psychotic disorders (BSP). We evaluated various statistical models for predicting CTloss using deviance, Akaike information criterion, Vuong test, squared correlation and observed vs. expected (O/E) ratios. We also used logistic regression to investigate risk factors that impacted medication nonadherence, another quality measure for patients with bipolar disorders (BD). Results: Mean CTloss was 12.1 (±31.0 SD) days in the study population; it varied greatly across ACOs. For risk adjustment modeling, we recommended the zero-inflated Poisson or doubly augmented beta model. The O/E ratio ranged from 0.4 to 1.2, suggesting variation in quality, after adjusting for differences in patient characteristics for which ACOs served as reflected in E. Almost half (47.7%) of BD patients were nonadherent to second-generation antipsychotics. Patient demographics, medical and mental comorbidities, receiving institutional services like those from the Department of Mental Health, homelessness, and neighborhood socioeconomic stress impacted medication nonadherence. Conclusions: Valid quality measures are essential to value-based payment. Heterogeneity implies the need for risk adjustment. The search for a model type is driven by the non-standard distribution of CTloss.