Thesis (MA)--University of Montana, 2009. / Contents viewed on November 24, 2009. "Major Subject: Communication Studies" Title from author supplied metadata. Includes bibliographical references.

Pharmaceutical manufacturers’ use of prescription brand-name drugs coupons and vouchers to subsidize patients’ cost-sharing obligations such as co-pays has increased. The co-pays are used by managed care organizations (MCOs) to give their plan members an appreciation of drug costs as well as to offer incentives to use available equivalent generic alternatives due to lower co-pays. With higher tiered co-pays for brand-name drugs being offset by coupons, little is known about MCO representatives’ perceptions about use of co-pay subsidy coupons for brand-name prescription drugs. The objective of this study was to assess health plan managers and pharmacy benefit managers (PBMs) perceptions on the use of prescription drug co-pay subsidy coupons. An online survey instrument was used to collect data. A convenience sample of 834 MCO representatives was selected from the Academy of Managed Care Pharmacy (AMCP) membership directory. A total of 122 surveys were returned of which 105 were usable surveys, giving a response rate of 13.7%. A five-point, 11-item Likert scale ranging from 1 through 5, (1 = ‘Strong Disagree’ and 5 = ‘Strongly Agree’) was used to measure respondents’perceptions. Some items referred to coupons used to get co-pay discounts repeatedly over a year (i.e., long-term use coupons) while some items referred to coupons distributed for trial purposes (i.e., short-term use coupons). Of the 105 respondents, 42 (40%) “agreed,” while 58 (55.2%) “strongly agreed” that co-pay subsidy coupons encouraged non-preferred brand-name drugs over preferred brand-name drugs. A total of 78 respondents (74.3%) reported that brand-name drug coupons undermined tiered formulary structure. Sixty respondents (57.1%) “strongly agreed” that short-term use coupons increased plan sponsor’s costs and 72 respondents (68.6%) “agreed” that sponsor cost increased with long-term use coupons. A total of 42 (40%) reported to “strongly agree” that short-term use coupons should be eliminated whereas 49 (46.7%) respondents reported “strongly agreed” that long-term use coupons should be eliminated. In summary, MCO representatives believe that brand-name drug utilization is increasing due to prescription drug incentives such as coupons which undermines their formulary controls and in turn, increases health care costs. / text

Prescription drugs play an increasingly significant role in the Canadian healthcare system. Drug spending accounts for a considerable share of total healthcare expenditure and continues to be one of the fastest growing expenditure components in Canada. But, drug manufacturers’ price setting behaviours are not well understood in the literature. I develop a framework of oligopoly theory with two-dimension product differentiation based on a synthesis of the literature on the institutional history and development of the Canadian pharmaceutical system. I find that: (1) The differentiation in perceived quality between brand-name and generic drugs can explain the generic competition paradox. The degree of the product differentiation can be pivotal in shaping the brand-name drug manufacturers’ price setting behaviours in response to the shift in patients’ preference and changes in government policies. (2) Copay and generic drug price-cap policies are commonly adopted by the Canadian public drug plans to contain drug reimbursement cost. Policy-makers should use caution when applying these policies in combination or separately in order to reach the intended outcomes. (3) The generic drug price-cap can elicit competition among brand-name drug manufacturers, but it may need coordinated regulations on patented drug prices. Without full coordination among major stakeholders and across jurisdictions, the benefits of lowered drug prices for some can become additional costs for others. I innovatively adopt the multilevel model to analyze the pharmaceutical market structure and evaluate the net effect of the generic competition paradox. The empirical research on the drug price dynamics is consistent with the predictions of the previously developed theory. I find that: (1) More generic substitutes in a drug molecule are associated with a net effect of increases in drug prices, after other contextual variables are properly controlled for. (2) More therapeutic substitutes do not have a net effect of lowering drug prices. (3) When a generic substitution policy is in place, the studied brand-name drugs maintain net price premiums over their generic substitutes. But, the net price premiums in the case when there is a generic substitution policy are lower than those where there is no such policy.

Prescription opioid pain reliever utilization has been increasing since the 1990s, due in part to changes in recommendations for the treatment of chronic pain, but also to abuse and diversion. One innovative policy solution to the abuse and diversion of prescription opioids is state prescription drug monitoring programs (PDMPs), which provide prescribers and other selected parties with patient controlled substance dispensation history; thereby, correcting an information asymmetry problem between prescribers and patients. The widespread implementation of state PDMPs, which vary in program design and requirements, has resulted in a variety of intended and unintended consequences. Previous PDMP evaluations have suggested such outcomes as the reduction of consumer access to opioids, the influencing of healthcare provider prescribing behaviors for opioids, and the re-shaping of the United States market for prescription opioids. PDMPs may also be associated with unintended outcomes: namely, the restriction of pharmaceutical opioids could be associated with an increase in heroin use, as evidenced by increases in heroin substance abuse treatment facility discharges. The analyses in this project examine the influence of PDMPs on healthcare providers and the market for prescription drugs by comparing trends in opioid utilization in states with varying PDMP features using Medicaid prescription utilization data and commercial insurance claims. The effect of PDMPs on consumers is explored with an analysis comparing substance abuse treatment facility discharge data for heroin abuse with pharmaceutical opioid prescriptions before and after PDMP regulatory change. Finally, the impact of other related opioid policy interventions, opioid overdose medication access laws, are analyzed by comparing opioid overdose mortality across states with differing overdose medication access policies over time. Contributions to the understanding about the impacts of these state-level opioid abuse and diversion policies can be used to improve or amplify intended outcomes and ameliorate unintended consequences.

The goal of this research is to analyze the stigmatization of opioid addiction within the framework of emergency care from an ethnographic perspective. Interviews with those who have been swept up in the current opioid epidemic indicate that stigma, or a shame or dishonor, and socioeconomic insecurity emerge often as common themes in their emergency care experiences. In many cases, socioeconomic insecurity most intensely translates into a lack of access to healthcare and emergency rooms across the country often function as primary care for uninsured populations. The central field site selected for this study was the emergency department of an urban trauma-level research hospital in an attempt to document the process of care for those in opioid crisis and the challenges healthcare providers face in facilitating this care. The aim of this research is to discover how stigma affects care in emergency room settings during an acute opioid crisis. This is a moment when patients may be most open to the idea of detoxification and sobriety. In this study, I argue that addiction can be shifted from being viewed as a disgraceful state to a medical condition, by uncovering what experiences overdose victims have while under emergency care, how patients experience stigma related to their opioid crisis, and what challenges healthcare providers describe while facilitating care during crisis. Findings suggest that stigma permeates the interactions drug-addicted patients have with healthcare professionals and that it may have a negative impact on their decision to seek further treatment. Application of results in the form of a community resource guide made available to patients and hospital staff indicate the potential for reducing stigma of intravenous/opioid-related addiction as healthcare providers are more able to discern gaps in care for addicted patients and facilitate greater follow-up care and access to resources. This thesis illustrates the potential for qualitative analysis of acute care to uncover vital next steps in reducing the stigma surrounding opioid addiction. Reducing stigma in the provision of care could foster more integrative approaches to treatment, help inform new protocols for caregivers, uncover resources to aid healthcare providers, and potentially provide a more substantial level of care and access to resources for the patient in crisis—one that may facilitate recovery in lieu of relapse.

Certains médicaments agissant sur le système nerveux central ont comme particularité d'entraîner parfois des troubles de l'abus et de la dépendance. Ces effets indésirables sont étudiés avant la mise sur le marché du médicament, lors des essais cliniques et non cliniques. Cependant, l'abus est un phénomène plurifactoriel, influencé par des facteurs liés à la substance, individuels et environnementaux. Ces déterminants ne peuvent pas être pris en compte avant la mise sur le marché du médicament et rendent essentielle la surveillance de l'abus de médicaments après la mise sur le marché, par l'intermédiaire notamment d'études pharmacoépidémiologiques. Une surveillance efficace de l'abus de médicament implique de comprendre les déterminants de l'abus et ses mécanismes sous-jacents. L'objectif de ce travail de thèse est donc d'analyser des déterminants de l'abus en utilisant des approches pharmacoépidémiologiques. Le premier travail a été d'établir un état des lieux des systèmes de surveillance de l'abus de médicaments en France et à l'étranger (publication n°1). Nous avons par la suite utilisé une enquête en population auprès des patients fréquentant des centres de soins spécialisés pour les usagers de drogues, afin d'étudier l'impact de la mise sur le marché de génériques de la Buprénorphine Haut Dosage (BHD) sur l'abus de BHD (publication n°2). Cette étude nous a permis d'analyser l'influence de la formulation sur l'abus de médicaments. L'exploration de la localisation géographique comme déterminant de l'abus n'a jamais été réalisée en France. / Some central nervous system medications sometimes lead to abuse or dependence. These adverse effects are assessed using premarketing studies such as clinical trials and non clinical studies. However, abuse is influenced by many factors, substance-related, individual and environmental. These factors could not be taken into account in premarketing studies. Thus, postmarketing surveillance of prescription drug abuse, using in particular pharmacoepidemiologic studies is essential. An efficient postmarketing surveillance requires the comprehension of abuse-related factors and underlying mechanisms. The purpose of this work was to analyse prescription drug abuse factors using pharmacoepidemiological approaches. The first part of this work was an overview of postmarketing surveillance systems dedicated to prescription drug abuse in France and in foreign countries (publication n°1). Then, we used a survey in population of patients seen in care centres dedicated to drug users in order to assess the impact of buprenorphine maintenance generic introduction on buprenorphine maintenance abuse (publication n°2). This study allows to observe the influence of the formulation on prescription drug abuse. The factors related to geographic area have never been explored in France, at our knowledge. Therefore, we studied geographic variations of prescription opioid abuse in three regions of southern France, Provence-Alpes-Côte d'Azur-Corse, Rhône-Alpes and Midi-Pyrénées using a pharmacoepidemiologic approach based on prescription drug reimbursement database, the doctor shopping method (publication n°3).

Objectives are (1) Describe HIV/HCV prevalence in TN and Central Appalachia; (2) Understand syringe access in pharmacy settings. Identify and refer clients to local syringe service programs.

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Tennessee is ranked second in the nation for pain relievers also known as "opioid" prescriptions and it's affecting individuals, families and communities. Please join us as Tennessee Commissioner of Health Dr. John Dreyzehner kicks off this session with a plenary presentation of our health status as a state, an overview of the main challenges we are facing in this multifaceted issue, and ways we can work together to shape our environment for a healthier future. In conjunction with Governor Haslam's Prescription for Success initiative for Tennessee, partners across the state are supporting the efforts of the lead agency, the Tennessee Department of Mental Health and Substance Abuse Service, to improve the health and safety of our residents. The panel participants will discuss current and future efforts to secure additional drug disposal options, revise and improve state and local legislation, develop proactive workforce programs, and more.

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