VIEWS: 40 PAGES: 20 POSTED ON: 2/26/2012
Prescription Drug Dispensing Limits: A Barrier to Managing Chronic Conditions And Costs? Phillips KA, Liang SY, Haas J, Stebbins M, Alldredge B University of California, San Francisco Harvard University Funding from NCI & AHRQ Our “Strange” Attitudes Towards Drugs Did You Know? • Private health plans limit prescriptions to 30-day supply when filled at community pharmacies – >30-day supply only if mail order or self-pay – Some scrips should only be filled for 30-days or less but • Medicines used for chronic illness may often be appropriately filled for > 30 days And This is News! Medicare scrip benefit covers scrips for > 30 days at community pharmacies Why Care? Why important? Dispensing patterns adherence outcomes Yet virtually NO research on dispensing patterns! Objectives • Examine dispensing patterns for five drug classes for chronic conditions – Antidepressants (AD) – Antiepileptic drugs (AED) – Beta-blockers (BB) – Hormone replacement therapy (HRT) – Oral contraceptive pills (OCP) • Examine expenditures for 30-day vs > 30-day supplies Using Linked Data • 1996 & 2000 Medical Expenditure Panel Surveys – Nationally representative data – Data obtained from households then linked to pharmacies • Most comprehensive and accurate data available to our knowledge – But data do not enable examining outcomes of dispensing Who & Why? • Ongoing users only • To categorize dispensing patterns must: – Identify specific drugs (brand & generic names) – Identify standard dosing patterns This is hard work!! • Chose 5 drugs – Represent 20% of sales in US What Drugs? • Selected range of drugs: – Commonly prescribed – Used for chronic conditions – Safe to dispense > 30 days – Consistent dosing patterns – Variety of populations • One gender vs. both • All ages vs. younger vs. older Study Populations • Both genders and all ages for antidepressants (N=738) and antiepileptic drugs (N=306) • Both genders and ages 18+ for beta-blockers (N=842) • Females ages 50+ for hormone replacement therapy (N=878) • Female ages 18-35 for oral contraceptives (N=449) Outcome Measure • Prescriptions categorized as <=30 days or > 30 days – Based on pharmacy-reported quantity dispensed • Also RX strength and RX form – Three approaches to identify drug names and standard dosing patterns: • ePoctrates • Drug Information for the Health Care Professional • Clinical experts Results: Majority Get < 30 Days • Majority obtained <30-day supplies – 62% in 1996 – 66% in 2000 • Low use of mail order services – 12% in 1996 – 14% in 2000 • Different patterns by drugs – Higher % <30 day scrips if oral contraceptives, anti- epileptic drugs, & anti-depressants Disadvantaged Get < 30 days • Correlates of < 30 days – Younger – Male – Lower income – Less than high school education – Less satisfied can get health care – Uninsured – Non-Medicare – If privately insured, drug coverage – Type of drug • Most important predictors in regressions: – Lower income & type of drug Higher Expenditures if < 30 Days – Higher expenditures for patients (p<.001) • 50% higher out-of-pocket costs – Higher expenditures for insurers (p<.001) • Although does not include rebates, etc. Summary • Majority of individuals taking chronic medications obtained <30-day supplies – Little change between 1996 and 2000 • Disadvantaged individuals more likely to get <30-days supplies • Expenditures for <30-day supplies were higher than > 30-day supplies So Now What? Moving the Agenda Forward • Urgent need for further research: – Dispensing patterns – Alternatives (e.g., mail order) – Impact of dispensing patterns on costs and outcomes Policy Issues (AKA more work for researchers!) • New Medicare prescription drug benefit allows community pharmacies to dispense 90-day supplies • Increasing employer & insurers mandates to use mail order services • Understanding the impact on costs & outcomes (but need data) In God We Trust, All Others Bring Data Joe Newhouse
"Prescription Drug Benefit Dispensing Restrictions Barrier to"