Effects of a medication assistance program with medication therapy management on the health of renal transplant recipients.

PURPOSE: The effects of a medication assistance program with medication therapy management (MTM) on the clinical outcomes and health-related quality of life (HQOL) of renal transplant recipients were studied. METHODS: All renal transplant recipients who were enrolled in the Medication Access Program at the Medical College of Georgia for at least one year were included in the study. Patients' demographics, number of graft rejections (for one year pre-enrollment and one year post-enrollment), and diagnoses of hypertension, diabetes, and dyslipidemia were recorded and confirmed by medical and pharmacy records. The use of antihypertensive, antidiabetic, antilipemic, and immunosuppressant agents and laboratory values for fasting blood glucose, glycosylated hemoglobin (HbA(1c)), blood pressure, low-density-lipoprotein (LDL) cholesterol, total cholesterol, triglycerides, and serum immunosuppressant concentrations were identified for one year pre-enrollment and one year post-enrollment. HQOL was measured at the time of enrollment and one year post-enrollment. RESULTS: Thirty-six adult renal transplant recipients were included in the study. All patients had hypertension, 72% had dyslipidemia, and 42% had diabetes. Patients received significantly more antihypertensive agents post-enrollment versus pre-enrollment (p < 0.001) and significantly more antidiabetic agents (p = 0.004) and antilipemics (p = 0.001). Measures of fasting blood glucose, glycosylated hemoglobin, LDL cholesterol, total cholesterol, triglycerides, blood pressure, and number of graft rejections decreased from pre-enrollment levels (p < 0.01). A significantly greater number of patients reached target serum cyclosporine levels post-enrollment versus pre-enrollment (p = 0.008). HQOL was significantly increased one year post-enrollment (p < 0.01). CONCLUSION: A medication assistance program that included MTM services improved medication access, clinical outcomes, and HQOL in renal transplant recipients.

Influence of economic and demographic factors on quality of life in renal transplant recipients.

BACKGROUND: The purpose of this study was to determine the influence of annual income, Medicare status, and demographic variables on the health-related quality of life (HQoL) of renal transplant recipients. METHODS: A cross-sectional survey was mailed to 146 Georgia renal transplant recipients who had functional grafts. Data were collected using the SF-12 Health Survey (version 2), a demographics survey, and 2003 tax documents. One-way ANOVAs and Pearson's R correlations were used to examine relationships between annual income, Medicare status, demographic variables and SF-12 scores. Significant variables were included in stepwise multiple regression analyses. RESULTS: Data from 130 participants (89% response rate) were collected. Recipients with no Medicare coverage had significantly higher scores on the Physical Functioning and Role Physical SF-12 scales (p = 0.005) compared to recipients with Medicare. Annual income was positively correlated with General Health (p < 0.05). Age and race were significant predictors of Vitality (p = 0.004) and Physical Component Summary (p < 0.001) scores. Age, race, and Medicare status were significant predictors of Physical Functioning and Role Physical scores (p < 0.001). Age, annual income, race, and years post-transplant were significant predictors of General Health score (p < 0.001). Age was the sole predictor of Bodily Pain score (p = 0.002), and marital status was the sole predictor of Social Functioning score (p = 0.005). CONCLUSIONS: Interventions designed to offset financial barriers may be needed to bolster renal transplant recipients' HQoL.

Medicare-approved drug discount cards and prescription drug prices.

PURPOSE: Prescription drug prices with and without the use of Medicare-approved drug discount card programs (MADDCs) to purchase medications were studied. METHODS: The Medicare.gov Web site was used to determine if the 200 most frequently prescribed drugs in the United States in 2003 were covered by a MADDC. The lowest and highest MADDC prices at local and mail-order pharmacies and the corresponding non-MADDC prices at the same community pharmacies or an Internet pharmacy, respectively, were determined. Wilcoxon signed rank tests were used to determine if there was a difference between non-MADDC medication prices and MADDC prices. RESULTS: Of the top 200 medications prescribed in 2003, 192 (96%) and 189 (94.5%) were covered by at least one MADDC in a local pharmacy or mail-order pharmacy, respectively. Overall, MADDCs saved money compared with purchasing medications without a MADDC (p < 0.001). However, a MADDC resulted in a higher price than the retail non-MADDC price for 61 (31.8%) of the prescription medications at local pharmacies, and using a MADDC at a mail-order pharmacy resulted in a higher price than the Internet pharmacy non-MADDC price for 143 (75.7%) of the drugs. CONCLUSION: MADDC prices for common prescription medications were generally lower than prices when MADDCs were not used. The highest mail-order MADDC prices were often higher than Internet non-MADDC prices.

Medicare-approved drug discount cards and renal transplant patients: how much can these cards reduce prescription costs?

BACKGROUND: Post-transplant prescription medications are expensive, often costing over 12,000 dollars annually. Many solid-organ transplant patients have Medicare coverage and patients enrolled in Medicare-approved drug discount card (MADDC) programs may be able to receive prescription medications at a reduced price. However, many transplant healthcare practitioners are unaware of the utility of MADDCs. The purpose of this study was to determine whether enrolling renal transplant patients (RTPs) into a MADDC produces significant savings in prescription costs. METHODS: Two Medicare RTPs, with prescription medication profiles representative of an RTP within 3 months post-transplant and an RTP greater than 5 yr post-transplant, were randomly selected from the Medication Access Program's database. Cost benefit analyses were from the patients' perspective and were performed using the: (i) prescription cost from the Medicare website of MADDCs that listed the greatest and least prescription costs compared with the retail cash price of the same prescription without using the MADDCs; and (ii) MADDCs' annual enrollment fee. The potential cost difference of using MADDCs and not using MADDCs to purchase the prescription medications were calculated. RESULTS: RTPs' monthly out-of-pocket cost for prescription medications ranged from 162 dollars to 340 dollars, and MADDCs offered discounts of 20-37% from retail prices; thus outweighing the MADDC enrollment cost. CONCLUSION: MADDCs, when selected and used appropriately, can reduce prescription medication cost for RTPs. Card selection is of great importance as discount rates vary greatly among cards, and only under restricted circumstances is a patient allowed to switch to another card. It is imperative that practitioners are aware of these programs and utilize cost-effective prescribing practices.

Comparing renal transplant patients' adherence to free cyclosporine and free tacrolimus immunosuppressant therapy.

BACKGROUND: The purpose of this study is to determine if there is a difference in renal transplant patients' (RTPs) adherence to cyclosporine compared to tacrolimus when medications are supplied free to the RTPs. METHODS: Adult primary RTPs were included in the study if they received a renal transplant at the Medical College of Georgia (MCG) from June 1998 through August 2001 and received their first post-transplant year of follow-up care at MCG and free cyclosporine or free tacrolimus from the MCG outpatient pharmacy. Adherence was estimated by comparing each RTPs' tacrolimus or cyclosporine pharmacy refill records to the prescribed regimen for 12 months after transplant. Patients' cyclosporine and tacrolimus serum concentrations were used to validate adherence. Kaplan-Meier analysis was used to estimate the fraction of RTPs remaining adherent and to compare the mean time RTPs were adherent in each group (cyclosporine vs. tacrolimus). RESULTS: Thirty-three RTPs were included in the study, 25 (76%) received cyclosporine and eight received tacrolimus. The mean time to the first non-adherent month was 8 months post-transplant. At 12-months post-transplant, approximately 42% of the patients remained adherent. A greater percentage of the patients who received tacrolimus remained adherent compared with those who were taking cyclosporine (63% vs. 33%, p < 0.05). Approximately 75% of non-adherent patients were found to have subtarget drug concentrations, and only 24% of adherent patients had subtarget levels (p < 0.01). CONCLUSIONS: When provided free, patients are more adherent to tacrolimus than cyclosporine. Regardless of treatment, intensive efforts to increase adherence should be implemented.

Pharmaceutical manufacturer assistance programs.

BACKGROUND AND OBJECTIVE: While there have been many public discussions concerning Medicare covering outpatient prescription medications, currently, Medicare does not pay for most outpatient prescriptions. Meanwhile, costs associated with prescription medications as well as the number of underinsured patients are rapidly increasing. Many pharmaceutical companies offer assistance programs for patients who require medications but have inadequate financial resources to obtain them. Because patient access to required prescriptions is critical and clinician involvement is necessary for patient enrollment, the purpose of this article is to facilitate awareness of pharmaceutical companies' assistance programs, the availability of such programs, and their enrollment process. METHODS: English-language articles from MEDLINE (1963-2000) and Internet Web pages describing medication assistance programs were reviewed. Data obtained from pharmaceutical companies' medication assistance programs were also included. In addition to general information concerning medication assistance programs, all studies found in the literature search describing the clinical and financial impact of using these programs and data obtained from contacting several medication assistance programs were selected. To determine if an assistance program was available for a medication listed as one of the top 200 medications prescribed in the United States, we contacted the pharmaceutical company that manufactures each medication. RESULTS: Approximately 53% of the top 200 prescribed medications in 1999 were offered through assistance programs to indigent patients. Physician office personnel can obtain medications for eligible patients by completing the enrollment process. CONCLUSION: Pharmaceutical companies' medication assistance programs can be used to reduce individual patient drug expenditures and improve patient outcomes by increasing medication access to those in need.