Oncology drug pricing: potential Medicare savings on cancer-directed and supportive care medications through the Mark Cuban cost plus drug model.

Prescription drug costs within oncology remain a challenge for many patients with cancer. The Mark Cuban Cost Plus Drug Company (MCCPDC) launched in 2022, aiming to provide transparently priced medications at reduced costs. In this study, we sought to describe the potential impact of MCCPDC on Medicare Part-D oncology spending related to cancer-directed (n = 7) and supportive care (n = 26) drugs. We extracted data for drug-specific Part-D claims and spending for 2021. Using 90-count purchases from MCCPDC, we found potential Part-D savings of $857.8 million (91% savings) across the 7 cancer-directed drugs and $28.7 million (67% savings) across 21/26 (5/26 did not demonstrate savings) supportive care drugs. Collectively, our findings support that alternative purchasing models like MCCPDC may promote substantial health care savings.

Prescription drug coverage and effective coverage of three chronic conditions of high prevalence in Chile: Hypertension, diabetes and dyslipidemia.

BACKGROUND: Access to medicines is a serious problem globally and in Chile. Despite the creation of coverage policies, part of the population with chronic conditions of high prevalence, still does not have access to the medicines it requires and disease control continues to be low. The objective of the study was to estimate the medication use and effective coverage for diabetes, dyslipidemia and hypertension in Chile, analyzing them according to sociodemographic variables and social determinants of health. METHODS: Cross-sectional analytical study with information from the 2016-2017 National Health Survey (sample = 6,233 people aged 15 years or older, expanded = 14,518,969). Descriptive analyses of medication use and effective coverage for hypertension, diabetes and dyslipidemia were carried out, and multivariate logistic regression models were developed to analyze possible associations with variables of interest. RESULTS: 60% of people with hypertension or diabetes use medications and only 27.7% in dyslipidemia. While 54.2% of those with diabetes have their glycemia controlled, in hypertension and dyslipidemia the effective coverage drops to 33.3% and 6.6%, respectively. There are no differences in use by health system, but there are differences in the control of hypertension and diabetes, favoring beneficiaries of the private subsystem. Effective coverage of dyslipidemia and hypertension also increases in those using medications. The drugs coincide with the established protocols, although beneficiaries of the private sector report greater use of innovative drugs. CONCLUSION: A significant proportion of Chileans with hypertension, diabetes or dyslipidemia still do not use the required medications and do not control their conditions.

Ability to pay for medication: a clustering analysis of 1404 patients with the Patient Financial Eligibility Tool.

Aim: The study was conducted to understand how key determinants of the Patient Financial Eligibility Tool (PFET), a previously validated tool for assessing patients' ability to contribute to their medication costs, vary across countries. Materials & methods: A clustering analysis was conducted on economic data from 1404 patients from Thailand (n = 947), the UAE (n = 347) and Mexico (n = 110). Results: The analysis identified seven patient clusters, including globally wealthy or poor patients (14%/48%) and those with only selectively increased PFET economic indicators (38%), and revealed country-specific differences in the correlation between PFET metrics and patients' overall economic status. Conclusion: The PFET is a versatile tool that can be adapted to each country's economic context to assess patients' ability to contribute to their medication costs.

Gasto de Bolsillo en Salud y Medicamentos en Chile: Análisis Comparativo de los Periodos 1997, 2007, y 2012.

OBJECTIVES: Out-of-pocket spent (OPS) of health services are considered inefficient and are a consequence of inequalities in financing and access. The main objective of this study was to compare OPS on health and medicine, including catastrophic expenditure, overall and by quintiles and deciles, for the great Santiago city in the periods 1997, 2007 and 2012. METHODS: Cross-sectional study based on household budget surveys 1997, 2007 and 2012. OPS on health and medicine for households of the great Santiago was estimated overall and for different quintiles and deciles. In addition, the probability of incurring in catastrophic due to health and drug expenditure were also estimated. RESULTS: OPS showed a progressive increase in the three periods. Drug spending showed a decrease concentrated in the lower deciles and an increase in top deciles of expenditure. Catastrophic drug expenditure decreased progressively. By observing the catastrophic drug spending by deciles were the three richest deciles which showed a large increase between 2007 and 2012. CONCLUSIONS: OPS on health remained high between 2007 and 2012, despite presenting slight decreases in some quintiles and deciles. However, drug coverage improved over time. This study demonstrates that improvements are needed in the financial protection mechanisms on health in Chile, especially for poorer quintiles and deciles.

Access to prescribed medicine in the Brazilian adult population. / Acesso da população brasileira adulta a medicamentos prescritos.

OBJECTIVE: To estimate the prevalence and check the factors associated with access to prescribed medicine by the Brazilian adult population; and to describe the distribution of the presence of monetary expenditure for the purchase, source of medicines, and the reasons for non-access. METHODS: Based on a cross-sectional design, from the 2013 National Health Research data, we analyzed a representative sample of the population that comprised adults with prescriptions written by a health professional, in the two weeks prior to the survey. The dependent variable was the access to prescribed medicines (full access, partial access, no access). Data were analyzed using the multinomial logistic regression considering total access as the reference category. RESULTS: The results showed high prevalence of full access to prescribed medicine in Brazil (83.0%; 95%CI 81.3 - 84.6). Most of the individuals had monetary expenditure on the purchase of medicines (63.9%), and the main reasons for no access were the lack of medicine in the public health service (57.6%) and having no money (11.9%). We found higher chances of partial access among individuals attending the public service (OR = 2.5; 95%CI 1.58 - 3.97). Greater chance of no access was associated with non-white skin color (OR = 1.43; 95%CI 1.03 - 1.99). CONCLUSION: The results revealed significant inequity in access to medicine, emphasizing the need to strengthen the Unified Health System for the free supply of medicines in order to reduce inequalities.

Análisis de los Determinantes Socioeconómicos del Gasto de Bolsillo en Medicamentos en Seis Zonas Geográficas de Panamá.

OBJETIVO: Caracterizar el gasto de bolsillo privado en medicamentos en función de los determinantes sociodemográficos y socioeconómicos. MATERIALES Y MéTODOS: La fuente de datos es la Encuesta de Gasto de Bolsillo en Medicamentos de 2014. Se caracterizó el gasto de bolsillo privado mediante variables explicativas sociodemográficas (SOD) y socioeconómicas (SES). Se hizo análisis factorial por componentes principales, regresión logística y lineal simple. RESULTADOS: Los Odds Ratio demuestran que la educación y la zona geográfica son determinantes fundamentales que inciden en el gasto de bolsillo. Los medicamentos son productos necesarios, en adición a que el gasto de bolsillo aumenta a un promedio del 2% por cada año de vida cronológica adicional. CONCLUSIONES: Existe mayor vulnerabilidad en las zonas más pauperizadas respecto del acceso a medicamentos, en especial en las indígenas e implica un mayor riesgo de gasto catastrófico a menor ingreso ante la mayor prevalencia de enfermedades crónicas.

BRIC Health Systems and Big Pharma: A Challenge for Health Policy and Management.

BRIC nations - Brazil, Russia, India, and China - represent 40% of the world's population, including a growing aging population and middle class with an increasing prevalence of chronic disease. Their healthcare systems increasingly rely on prescription drugs, but they differ from most other healthcare systems because healthcare expenditures in BRIC nations have exhibited the highest revenue growth rates for pharmaceutical multinational corporations (MNCs), Big Pharma. The response of BRIC nations to Big Pharma presents contrasting cases of how governments manage the tensions posed by rising public expectations and limited resources to satisfy them. Understanding these tensions represents an emerging area of research and an important challenge for all those who work in the field of health policy and management (HPAM).

Economic burden of varicella in children 1-12 years of age in Argentina, 2009-2014.

BACKGROUND: In Argentina, varicella vaccination was included in the national schedule for mandatory immunizations in 2015. The vaccine has been shown to substantially reduce the morbidity and mortality associated with the virus. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Argentina prior to vaccine introduction. METHODS: This was a multi-center, retrospective chart review study among patients aged 1-12 years with a primary varicella diagnosis in 2009-2014 in Argentina. Healthcare resource utilization (HCRU) associated with varicella and its complications, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 United States dollars (USD). RESULTS: One hundred and fifty children with varicella were included (75 outpatients, 75 inpatients), with a mean age of 3.8 (SD = 2.4) and 2.9 (SD = 2.2) years, respectively. One or more complications were experienced by 28.0% of outpatients and 98.7% of inpatients, the most common being skin and soft tissue infections, pneumonia, sepsis, cerebellitis, and febrile seizure. HCRU estimates included use of over-the-counter (OTC) medications (58.7% outpatients, 94.7% inpatients), prescription medications (26.7% outpatients, 77.3% inpatients), tests/procedures (13.3% outpatients, 70.7% inpatients), and consultation with allied health professionals (1.3% outpatients, 32.0% inpatients). The average duration of hospital stay was 4.9 (95% CI = 4.2-5.7) days, and the average duration of ICU stay was 4.8 (95% CI = 1.6-14.1) days. The total combined direct and indirect cost per varicella case was 2947.7 USD (inpatients) and 322.7 USD (outpatients). The overall annual cost of varicella in Argentina for children aged ≤14 years in 2015 was estimated at 40,054,378.0 USD. CONCLUSION: The clinical burden of varicella in Argentina was associated with utilization of significant amounts of healthcare resources, resulting in substantial economic costs. These costs should be reduced with the recent implementation of routine vaccination of children.

Acesso da população brasileira adulta a medicamentos prescritos / Access to prescribed medicine in the Brazilian adult population

RESUMO: Objetivo: Estimar a prevalência e verificar os fatores associados ao acesso a medicamentos prescritos, pela população adulta brasileira, e descrever as distribuições de dispêndio monetário para acesso aos fármacos, fonte de obtenção e motivos para o não acesso. Métodos: Com base em um delineamento transversal, a partir dos dados da Pesquisa Nacional de Saúde de 2013, analisou-se uma amostra composta por indivíduos adultos que tiveram medicamentos prescritos por profissional de saúde, nas duas semanas anteriores à realização da pesquisa. A variável dependente foi o acesso a medicamentos prescritos (total, parcial, nulo). Os dados foram analisados por meio de regressão logística multinomial, considerando-se o acesso total como categoria de referência. Resultados: Os resultados mostraram alta prevalência de acesso total a medicamentos prescritos no Brasil (83,0%; IC95% 81,3 - 84,6). A maioria dos indivíduos teve dispêndio monetário com a obtenção dos fármacos (63,9%), sendo que os principais motivos para o não acesso foram a ausência do medicamento no serviço público de saúde (57,6%) e falta de dinheiro (11,9%). Foram observadas maiores chances de acesso parcial para os indivíduos atendidos no serviço público (OR = 2,5; IC95% 1,58 - 3,97). Maior chance de acesso nulo foi associada à cor de pele não branca (OR = 1,43; IC95% 1,03 - 1,99). Conclusão: Os resultados revelaram iniquidade no acesso a medicamentos, reforçando a necessidade de fortalecimento do Sistema Único de Saúde para o fornecimento gratuito de fármacos, de modo a reduzir as desigualdades.

ABSTRACT: Objective: To estimate the prevalence and check the factors associated with access to prescribed medicine by the Brazilian adult population; and to describe the distribution of the presence of monetary expenditure for the purchase, source of medicines, and the reasons for non-access. Methods: Based on a cross-sectional design, from the 2013 National Health Research data, we analyzed a representative sample of the population that comprised adults with prescriptions written by a health professional, in the two weeks prior to the survey. The dependent variable was the access to prescribed medicines (full access, partial access, no access). Data were analyzed using the multinomial logistic regression considering total access as the reference category. Results: The results showed high prevalence of full access to prescribed medicine in Brazil (83.0%; 95%CI 81.3 - 84.6). Most of the individuals had monetary expenditure on the purchase of medicines (63.9%), and the main reasons for no access were the lack of medicine in the public health service (57.6%) and having no money (11.9%). We found higher chances of partial access among individuals attending the public service (OR = 2.5; 95%CI 1.58 - 3.97). Greater chance of no access was associated with non-white skin color (OR = 1.43; 95%CI 1.03 - 1.99). Conclusion: The results revealed significant inequity in access to medicine, emphasizing the need to strengthen the Unified Health System for the free supply of medicines in order to reduce inequalities.

Protecting Pharmaceutical Patents and Test Data: How the Trans-Pacific Partnership Agreement Could Affect Access to Medicines in the US and Abroad.

The Trans-Pacific Partnership (TPP) Agreement is a proposed free trade agreement between the US and 11 other countries in Asia and South America covering many consumer goods, including prescription medicines. This review describes how the TPP could affect international laws governing intellectual property rights for prescription drugs, focusing on patents and exclusivity protections for test data, including their effect on reimbursement decisions by national health care authorities responsible for health priority setting. We conclude that the TPP could affect low-income patients' access to medicines in signatory countries.

Does Pharmaceutical Pricing Transparency Matter? Examining Brazil's Public Procurement System.

BACKGROUND: We review procurement and pricing transparency practices for pharmaceutical products. We specifically focus on Brazil and examine its approach to increasing pricing transparency, with the aim of determining the level of effectiveness in lower prices using a tool (Banco de Preços em Saúde, BPS) that only reveals purchase prices as compared to other tools (in other countries) that establish a greater degree of price transparency. METHODS: A general report of Preços em Saúde (BPS) and Sistema Integrado de Administração de Serviços Gerais (SIASG) pricing data was created for 25 drugs that met specific criteria. To explore the linear time trend of each of the drugs, separate regression models were fitted for each drug, resulting in a total of 19 models. Each model controlled for the state variable and the interaction between state and time, in order to accommodate expected heterogeneity in the data. Additionally, the models controlled for procurement quantities and the effect they have on the unit price. Secondary analysis using mixed effects models was also carried out to account for the impact that institutions and suppliers may have upon the unit price. Adjusting for these predictor variables (procurement quantities, supplier, purchasing institution) was important to determine the sole effect that time has had on unit prices. A total of 2 x 19 = 38 models were estimated to explore the overall effect of time on changes in unit price. All statistical analyses were performed using the R statistical software, while the linear mixed effects models were fitted using the lme4 R package. RESULTS: The findings from our analysis suggest that there is no pattern of consistent price decreases within the two Brazilian states during the five-year period for which the prices were analyzed. CONCLUSIONS: While the BPS does allow for an increase in transparency and information on drug purchase prices in Brazil, it has not shown to lead to consistent reductions in drug purchase prices for some of the most widely used medicines. This is indicative of a limited model for addressing the challenges in pharmaceutical procurement and puts into question the value of tools used globally to improve transparency in pharmaceutical pricing.

The influence of health expenditures on household impoverishment in Brazil.

OBJECTIVE: To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. METHODS: Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. RESULTS: After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. CONCLUSIONS: Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.

The influence of health expenditures on household impoverishment in Brazil / Influência dos gastos em saúde no empobrecimento de domicílios no Brasil

OBJECTIVE To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. METHODS Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. RESULTS After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. CONCLUSIONS Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged. .

OBJETIVO Analisar a variação na proporção de domicílios vivendo abaixo da linha de pobreza no Brasil e os fatores associados ao empobrecimento. MÉTODOS Foram analisados os dados de despesa e renda das Pesquisas de Orçamentos Familiares conduzidas no Brasil em 2002-2003 (n = 48.470 domicílios) e 2008-2009 (n = 55.970 domicílios) com amostra representativa nacional. Foram utilizados dois pontos de corte para definir pobreza. O primeiro, recomendado pelo Programa Bolsa-Família, considerou pobreza rendimento per capita mensal inferior a R$100,00 em 2002-2003 e a R$140,00 em 2008-2009. O segundo, proposto pelo Banco Mundial, incorpora a correção pela paridade do poder de compra, resultando em US$2,34 por dia, em 2002-2003, e US$3,54, em 2008-2009. Para identificar os fatores sociodemográficos associados ao empobrecimento dos domicílios foi utilizada regressão logística. RESULTADOS Houve acréscimo de domicílios vivendo abaixo da linha de pobreza no Brasil após subtração dos gastos em saúde. Considerando-se a linha de pobreza recomendada pelo Banco Mundial, em 2002-2003 o acréscimo foi 2,6 pontos percentuais (ou 6,8%) e, em 2008-2009, 2,3 pontos percentuais (ou 11,6%). Considerando-se a linha de pobreza utilizada pelo Programa Bolsa-Família, a variação foi 1,6 (11,9%) e 1,3 (17,3%), respectivamente. Gastos com medicamentos foram os que mais contribuíram para o aumento de domicílios pobres. Os fatores associados ao empobrecimento, segundo a linha de pobreza do Banco Mundial, foram apresentar pior situação econômica, ser chefiado por indivíduo com baixa escolaridade, presença de crianças e ausência de idosos. Utilizando-se a linha de pobreza do Bolsa-Família, os fatores associados foram apresentar pior situação econômica e presença de crianças. ...

Relationship between functional fitness, medication costs and mood in elderly people.

OBJECTIVE: To verify if functional fitness (FF) is associated with the annual cost of medication consumption and mood states (MSt) in elderly people. METHODS: A cross-sectional study with 229 elderly people aged 65 years or more at Santa Casa de Misericórdia de Coimbra, Portugal. Seniors with physical and psychological limitations were excluded, as well as those using medication that limits performance on the tests. The Senior Fitness Test was used to evaluate FF, and the Profile of Mood States - Short Form to evaluate the MSt. The statistical analysis was based on Mancova, with adjustment for age, for comparison between men and women, and adjustment for sex, for comparison between cardiorespiratory fitness quintiles. The association between the variables under study was made with partial correlation, controlling for the effects of age, sex and body mass index. RESULTS: An inverse correlation between cardiorespiratory fitness and the annual cost of medication consumption was found (p < 0.01). FF is also inversely associated with MSt (p < 0.05). Comparisons between cardiorespiratory fitness quintiles showed higher medication consumption costs in seniors with lower aerobic endurance, as well as higher deterioration in MSt (p < 0.01). CONCLUSION: Elderly people with better FF and, specifically, better cardiorespiratory fitness present lower medication consumption costs and a more positive MSt.

Relationship between functional fitness, medication costs and mood in elderly people / Relações entre aptidão física funcional, custos com consumo de medicamentos e estados de humor em pessoas idosas

Objective: to verify if functional fitness (FF) is associated with the annual cost of medication consumption and mood states (MSt) in elderly people. Methods: a cross-sectional study with 229 elderly people aged 65 years or more at Santa Casa de Misericórdia de Coimbra, Portugal. Seniors with physical and psychological limitations were excluded, as well as those using medication that limits performance on the tests. The Senior Fitness Test was used to evaluate FF, and the Profile of Mood States - Short Form to evaluate the MSt. The statistical analysis was based on Mancova, with adjustment for age, for comparison between men and women, and adjustment for sex, for comparison between cardiorespiratory fitness quintiles. The association between the variables under study was made with partial correlation, controlling for the effects of age, sex and body mass index. Results: an inverse correlation between cardiorespiratory fitness and the annual cost of medication consumption was found (p < 0.01). FF is also inversely associated with MSt (p < 0.05). Comparisons between cardiorespiratory fitness quintiles showed higher medication consumption costs in seniors with lower aerobic endurance, as well as higher deterioration in MSt (p < 0.01). Conclusion: elderly people with better FF and, specifically, better cardiorespiratory fitness present lower medication consumption costs and a more positive MSt. .

Objetivo: verificar se a aptidão física funcional (AFF) tem associação com o custo anual de consumo de medicamentos e com os estados de humor (EH) em pessoas idosas. Métodos: estudo transversal com 229 idosos de 65 anos de idade ou mais da Instituição Santa Casa de Misericórdia de Coimbra, Portugal. Foram excluídos os idosos com limitações físicas e psicológicas e os que usavam medicamentos que condicionariam a realização dos testes. Foram utilizados a bateria Senior Fitness Test e o questionário Profile of Mood States - Short Form como instrumentos de coleta de dados. A análise estatística recorreu à Mancova, com ajuste de idade, para comparação entre homens e mulheres, e ajustada também para o sexo, para comparação entre quintis da aptidão cardiorrespiratória. A associação entre as variáveis de interesse foi feita com a correlação parcial, corrigindo o efeito da idade, do sexo e do índice de massa corpórea. Resultados: verificou-se a existência de correlação inversa entre a aptidão cardiorrespiratória e o custo anual de consumo de medicamentos (p < 0,01). A AFF associou-se também inversamente com os EH (p < 0,05). As comparações entre os quintis da aptidão cardiorrespiratória revelaram maior consumo de medicamentos em idosos com menor resistência aeróbia, assim como maior deterioração dos EH (p < 0,01). Conclusão: idosos com melhor AFF e, particularmente, melhor aptidão cardiorrespiratória apresentam menores custos com consumo de medicamentos e EH mais positivos. .

Nonlinear pricing in drug benefits and medication use: the case of statin compliance in Medicare Part D.

OBJECTIVE: To examine how enrollees' statin compliance responds to expected prices in Medicare Part D, which features a nonlinear price schedule due to a coverage gap. DATA SOURCES/STUDY SETTING: Prescription Drug Event data for a 5 percent random sample of Medicare Advantage Prescription Drug Plan enrollees in 2008 who did not receive a low-income subsidy. STUDY DESIGN: We analyze statin compliance prior to the coverage gap, where the "effective price" is higher than the actual copayment for drugs because consumers anticipate that more spending will make them more likely to reach the gap. We construct each enrollee's effective price as her expected price at the end of the year, which is the weighted average between pre-gap and in-gap copayments with the weight being the predicted probability of hitting the gap. Compliance is defined as at least 80 percent of days covered. PRINCIPAL FINDINGS: Part D enrollees' pre-gap statin compliance decreases by 3.7-4.7 percentage points for a $10 increase in the effective price. CONCLUSION: The presence of a coverage gap decreases statin compliance prior to the gap, suggesting that incorporating expected future prices is important to assess the full impact of cost sharing on drug compliance under nonlinear price schedules.

Can health insurance improve employee health outcome and reduce cost? An evaluation of Geisinger's employee health and wellness program.

OBJECTIVE: To evaluate the impact of a health plan-driven employee health and wellness program (known as MyHealth Rewards) on health outcomes (stroke and myocardial infarction) and cost of care. METHODS: A cohort of Geisinger Health Plan members who were Geisinger Health System (GHS) employees throughout the study period (2007 to 2011) was compared with a comparison group consisting of Geisinger Health Plan members who were non-GHS employees. RESULT: The GHS employee cohort experienced a stroke or myocardial infarction later than the non-GHS comparison group (hazard ratios of 0.73 and 0.56; P < 0.01). There was also a 10% to 13% cost reduction (P < 0.05) during the second and third years of the program. The cumulative return on investment was approximately 1.6. CONCLUSION: Health plan-driven employee health and wellness programs similarly designed as MyHealth Rewards can potentially have a desirable impact on employee health and cost.

[Evolution of consumption of high-cost drugs in Colombia]. / Evolución del consumo de medicamentos de alto costo en Colombia.

OBJECTIVE: Determine the patterns of consumption of high-cost drugs (HCD) during the 2005-2010 period in a population of Colombian patients enrolled in the General System of Social Security in Health. METHODS: An observational descriptive study was conducted. The prescription data of formulas of any drug considered to be high-cost dispensed to all users (1 674 517) in 20 cities of Colombia between 2005 and 2010 were analyzed. The anatomical therapeutic classification was considered, and the number of patients as well as monthly invoicing for each drug, the daily dose defined, and the cost per 1 ;000 inhabitants/day were defined. RESULTS: Over the entire study period, the amount invoiced for HCDs increased by 847.4%. Antineoplastic and immunomodulator drugs accounted for 46.3% of the total invoicing. The other drugs were anti-infectives (15.2%), systemic hormonal preparations (9.5%), and drugs for the nervous system (9.1%). Most of these drugs were prescribed at the daily doses defined as recommended by the World Health Organization, but with high costs per 1000 inhabitants/day. CONCLUSIONS: In Colombia a crisis has occurred in recent years due to the high spending generated by the most expensive drugs. The progressive growth of pharmaceutical spending is greater than the increased coverage by the country's health system. The Colombian health system should evaluate how much it is willing to pay for the most expensive drugs for some diseases and what strategies should be implemented to cover these expenses and thus guarantee access to the insured.

Report on Honduras: ripples in the pond--the financial crisis and remittances to chronically ill patients in Honduras.

The U.S. financial crisis has affected employment opportunities for Latino immigrants, and this could affect their ability to send financial assistance, or "remittances", to chronically ill family members in their home country. In a cross-sectional survey of 624 chronically ill adults conducted in Honduras between June and August 2009, respondents reported their receipt of remittances, health service use, and cost-related access barriers. Fifty-four percent of respondents reported relatives living outside the country, and of this group, 66 percent (37% of the overall sample) received remittances. Seventy-four percent of respondents receiving remittances reported a decrease over the prior year, mostly due to job losses among their relatives abroad. Respondents reporting reductions in remittances received significantly less per month, on average, than those without a reduction (US $170 vs. $234; p = 0.01). In multivariate models, respondents experiencing a reduction in remittances used fewer health services and medications due to cost concerns. Remittance payments from relatives resident in the United States are a major source of income for chronically ill individuals in Latin America. Most recipients of remittances reported a reduction during the financial downturn that affected their access to care.