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1.
Nutrients ; 15(2)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36678198

RESUMO

Data about the characteristics and prevalence of complementary medicine (CM) product use by Australians, including concurrent use with prescription and over-the-counter medications, have not been collected in the last five years. A cross-sectional online survey involving a representative sample of the Australian population was administered in 2021-2022. Of the 2351 survey responses included in this study, 49.4% reported use of a CM product over the previous 12-month period. Of these, 50% reported they always or often used CM products on the same day as a prescription medicine. Participants aged 65 and over were five times more likely to use CMs and other medications on the same day compared to 18-24-year-olds. Lower levels of education and having a chronic illness were also predictors of same-day use. The prevalence and characteristics of CM use by participants was similar to data collected five years ago. The study shows that concurrent use of CM products with prescription medications among older and more vulnerable populations is prevalent and this area requires further research to help ensure appropriate and safe use of CM products.


Assuntos
Terapias Complementares , Medicamentos sob Prescrição , Humanos , Estudos Transversais , Prevalência , Austrália/epidemiologia , Prescrições , Medicamentos sob Prescrição/uso terapêutico
2.
Ther Drug Monit ; 45(1): 35-44, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36624575

RESUMO

BACKGROUND: The general population widely uses herbal medicines, as they are regarded as effective and safe. St. John's wort, which is an effective herbal antidepressant, exhibits both pharmacokinetic and pharmacodynamic interactions with several drugs. The aim of this review was to highlight the clinically significant interactions of St. John's wort with drugs that require to be monitored to assess their therapeutic effect. METHODS: Published literature was searched using electronic databases, such as MEDLINE, PubMed, and Elsevier ScienceDirect using terms such as "herbal medicine," "herbal toxicity," "legislation herbal medicine," "drug-herb interactions," "St. John's wort," and "St. John's wort-drug interactions." Searches were limited to the English language, and there was no restriction on the date of publication. RESULTS: St. John's wort exhibits a number of pharmacokinetic and pharmacodynamic interactions with drugs. The most dangerous interactions occurred when used concurrently with the immunosuppressants, cyclosporine, and tacrolimus (treatment failure or organ rejection) or warfarin (treatment failure resulting in thromboembolic events) or antiretroviral agents (treatment failure and the emergence of new viral variants that are resistant to conventional drugs). CONCLUSIONS: Patients should consult their health care providers before consuming herbal supplements, especially St. John's wort, to avoid potentially dangerous drug-herb interactions.


Assuntos
Hypericum , Medicamentos sob Prescrição , Humanos , Monitoramento de Medicamentos , Imunossupressores , Antirretrovirais , Interações Medicamentosas , Extratos Vegetais , Interações Ervas-Drogas
3.
JAMA Health Forum ; 4(1): e225218, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36705916

RESUMO

Importance: The Inflation Reduction Act of 2022 gives Medicare the authority to negotiate prices for certain prescription drugs. Which drugs will be selected and how prices will be negotiated remain unclear. Objective: To simulate drug selection and the minimum savings that would have been achieved at statutory ceiling prices if Medicare drug price negotiation had been implemented from 2018 to 2020. Design, Setting, and Participants: In this cross-sectional study, a policy simulation analysis of high-spending prescription drugs in Medicare Part B and Part D that were eligible for negotiation from January 2018 to December 2020 was performed from August 5 to November 20, 2022. Exposures: Eligibility criteria for selection and discounts afforded by the statutory ceiling prices for negotiation. Main Outcomes and Measures: The main outcomes were characteristics of drugs subject to negotiation and estimated Medicare savings from 2018 to 2020 that would have been achieved through spending at ceiling prices compared with existing net prices accounting for price concessions. Results: Among the 40 selected drugs, 35 were primarily reimbursed through Medicare Part D and 5 through Part B and 10 were biologics. The most common therapeutic classes were endocrine (11), neurologic or psychiatric (5), pulmonary (4), rheumatologic or immunologic (4), and cardiovascular (4). Median time from US Food and Drug Administration approval to selection was 12 years (IQR, 10-14 years). Three drugs faced generic competition in the 2 years between selection and price negotiation. For the remaining 37 drugs, estimated net Medicare spending from 2018 to 2020 was $55.3 billion; spending at ceiling prices would have been reduced by an estimated $26.5 billion, which represented 5% of estimated net Medicare drug spending during those 3 years. Conclusions and Relevance: In this cross-sectional study, simulating the drug price negotiation provisions in the Inflation Reduction Act of 2022 revealed important limitations, including strict selection criteria and the potential for drugs to become ineligible for negotiation during the 2 years between selection and prices taking effect. Despite these limitations, the policy still delivered substantial savings because ceiling prices offered steep discounts, in part, by erasing excess spending from price increases faster than inflation.


Assuntos
Medicare Part B , Medicamentos sob Prescrição , Estados Unidos , Negociação , Estudos Transversais , Custos de Medicamentos
4.
JAMA Health Forum ; 4(1): e225012, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36637815

RESUMO

Importance: The US spends far more on brand-name prescription drugs than other comparable countries. However, studies of prescription drug spending in the US are often limited because there can be substantial differences in the confidential rebates that drug manufacturers pay to Medicaid vs other payers. Objectives: To demonstrate an approach for improved estimation of Medicaid rebates through case studies of 18 top-selling drugs to better understand trends in net Medicaid and non-Medicaid spending and prices for brand-name drugs. Design, Settings, and Participants: This was a cross-sectional study of US pricing data from 2015 to 2019 derived from Medicaid State Drug Utilization data SSR Health, Medi-Span, the Federal Supply Schedule, and IQVIA. Pricing data for 18 top-selling brand-name drugs measured consistently in both SSR Health, which captures US sales reported by publicly traded companies, and IQVIA's top US prescription drugs by nondiscounted spending in 2015 to 2019. Data were accessed and analyzed from January 2019 to June 2021. Main Outcomes and Measures: Gross and net Medicaid and non-Medicaid drug spending for the sample of 18 drugs and prices corresponding to a 30-day supply of medication. Results: Medicaid aggregate gross spending for the 18 drugs in the sample increased 173%, from $3.6 billion in 2015 to $9.9 billion in 2019, and estimated net spending after discounts increased by 119%, from $1.4 billion to $3.0 billion. Medicaid inflation-linked rebates reduced average gross price per 30-day supply by an estimated 43% in 2019, and up to 67% for individual drugs. In addition to the basic rebate, the best price provision reduced the average gross price per 30-day supply by an estimated 3% in 2019 and up to 54% for individual drugs. Between 2015 and 2019 across all study drugs, estimated average non-Medicaid net 30-day prices were between 1.9 and 2.6 times higher than Medicaid net prices. Excluding adalimumab-a spending anomaly because of the entry of a new high-cost formulation-net prices weighted by average gross spending decreased annually by 1% from 2015 through 2019 for Medicaid, while increasing by 2% for non-Medicaid payers. Conclusions and Relevance: In this cross-sectional study of 18 top-selling brand-name drugs, excluding 1 anomaly, Medicaid average net prices declined from 2015 to 2019. Simultaneously, for non-Medicaid payers, net price increased more than previously published marketwide growth rates, raising the importance of restraining drug price growth in non-Medicaid markets. Rigorous and transparent methods to estimate Medicaid discounts are imperative to understand patterns in Medicaid and non-Medicaid prices and develop policies that better align drug prices with clinical benefits.


Assuntos
Custos de Medicamentos , Medicamentos sob Prescrição , Estudos Transversais , Medicaid , Custos e Análise de Custo
5.
Nursing ; 53(1): 39-44, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36573869

RESUMO

ABSTRACT: A patient's willingness and desire to adhere to their medication plan are affected by their beliefs about taking medications, their self-efficacy, health literacy level, ability to afford prescription drug costs, and relationship with their clinicians. This article details strategies for creating a collaborative relationship with the patient, developing trust, and nurturing medication adherence.


Assuntos
Letramento em Saúde , Medicamentos sob Prescrição , Humanos , Papel do Profissional de Enfermagem , Adesão à Medicação , Autoeficácia
6.
Clin Toxicol (Phila) ; 60(3): 342-347, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34545746

RESUMO

BACKGROUND: Fatal drug overdoses are predominantly attributed to opioids. Women of childbearing age are among those at greatest risk, underscoring the need to understand the overlapping risk of fatal poisoning in children. METHODS: A retrospective analysis of fatal poisonings among decedents aged 0-9 years captured in the National Violent Death Reporting System (NVDRS) from 2012 to 2017 was employed. Poisonings were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes for poisonings (T36-T50, Y10-Y19), toxic effects of substances (T51-T65), and assault (X85-X90). The frequency and types of drugs involved in poisonings were derived from toxicological analysis. Logistic regression was used to model the odds of fatal poisoning by decedent and perpetrator characteristics. Qualitative content analysis was used to contextualize the patterns of fatal poisonings. FINDINGS: 1850 violent deaths were identified; 7% (n = 122) were poisoning-related, and 50% of these were attributed to opioids. Next, benzodiazepines (8%), amphetamines (7%), and antidepressants (5%) were most prevalent. Among poisoning-related deaths, 25% involved homicide-suicide. No differences in deaths were observed according to child race/ethnicity, and the risk of fatal poisoning decreased 6% with each year of child age. Following qualitative analysis, three unique categories of fatal poisoning emerged: "intentional administration without documented benign intent", "intentional administration with benign intent", and "unclear administration". CONCLUSION: The high proportion of fatal poisonings in children attributed to opioids in this study suggests a need for universal dissemination and training of naloxone in households comprised of children living with parents experiencing, or in recovery for substance misuse. Findings also indicate a needed emphasis on safe storage practices and education to parents about the risk of prescription drug toxicity in children.


Assuntos
Intoxicação , Medicamentos sob Prescrição , Suicídio , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Intoxicação/epidemiologia , Vigilância da População , Estudos Retrospectivos , Estados Unidos/epidemiologia , Violência
7.
BMC Health Serv Res ; 22(1): 1506, 2022 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-36496405

RESUMO

BACKGROUND: The COVID-19 pandemic, and its associated social distancing measures, gave profound changes to the everyday and academic life of students in higher education. The current study is the first to use nation-wide data to evaluate the long-term effect of the pandemic and its countermeasures on university students' mental health care use. METHODS: Using nation-wide individual-level data, we studied mental health consultations in primary care (data available from January 2017 to February 2022) and dispensed prescription drugs used to treat anxiety, depression, and sleep disturbances (data available from October 2018 to February 2021) for first-year undergraduate university students. We compared changes over time in mental health care use in a pandemic cohort (12,501 first-year students enrolled in 2019) to the same change in a pre-pandemic cohort (25,990 first-year students enrolled in 2017 and 2018). Event study and difference-in-difference models allowed us to separate the impact of the pandemic, experienced by the pandemic cohort only, from secular and seasonal changes experienced by all cohorts. RESULTS: The percentage of students with a mental health consultation temporarily decreased during the first period of strict social distancing measures in March 2020. At the end of the second round with strict measures in April 2021, the level of mental health consultations increased by 73% (95% CI 40-106.3). There was also a 42% (95% CI 5.7-79.5) increase in mental health consultations in November 2021. No similar increases were observed for dispensed prescription drugs between March 2020 and February 2021. CONCLUSIONS: The COVID-19 pandemic was associated with increases in mental health consultations in primary care among students, especially during/after longer periods of strict social distancing measures. The benefits of social distancing measures in future pandemic preparedness should be weighed against the cost of potentially worsening mental health in vulnerable groups.


Assuntos
COVID-19 , Medicamentos sob Prescrição , Humanos , COVID-19/epidemiologia , Pandemias , Saúde Mental , Estudos de Coortes , Estudantes
8.
JAMA Health Forum ; 3(12): e224631, 2022 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-36484998

RESUMO

This cross-sectional study estimates how annual US drug spending would change if prices for prescription drugs were set at the value-based price.


Assuntos
Medicamentos sob Prescrição , Custos de Medicamentos , Custos e Análise de Custo , Renda
9.
Am J Manag Care ; 28(12): 635-637, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36525656

RESUMO

As Medicare Advantage increasingly becomes the dominant form of Medicare, meaningful and accurate comparisons with traditional fee-for-service Medicare will be increasingly important for both beneficiaries and policy makers. Recent debate among policy experts, government advisory bodies, and health plans highlights the need to create standardized comparison between the 2 Medicare programs. Supplemental benefits, Part B cost-sharing differences, and prescription drug benefits should be valued with a series of structured comparisons. Making this information transparent to beneficiaries through the plan finder would improve beneficiary decision-making. Finally, pragmatic comparisons would support policy makers in making improvements to Medicare Advantage program policy, undertaking comparative program evaluation, and engaging in Medigap plan oversight.


Assuntos
Medicare Part C , Medicamentos sob Prescrição , Idoso , Estados Unidos , Humanos , Seguro de Saúde (Situações Limítrofes) , Custo Compartilhado de Seguro , Planos de Pagamento por Serviço Prestado
10.
Sci Rep ; 12(1): 20314, 2022 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-36433981

RESUMO

Information on effects of medication therapies during pregnancy is lacking as pregnant patients are often excluded from clinical trials. This retrospective study explores the potential of using electronic health record (EHR) data to inform safety profiles of repurposed COVID medication therapies on pregnancy outcomes using pre-COVID data. We conducted a medication-wide association study (MWAS) on prescription medication exposures during pregnancy and the risk of cesarean section, preterm birth, and stillbirth, using EHR data between 2010-2017 on deliveries at PennMedicine. Repurposed drugs studied for treatment of COVID-19 were extracted from ClinicalTrials.gov (n = 138). We adjusted for known comorbidities diagnosed within 2 years prior to birth. Using previously developed medication mapping and delivery-identification algorithms, we identified medication exposure in 2,830 of a total 63,334 deliveries; from 138 trials, we found 31 medications prescribed and included in our cohort. We found 21 (68%) of the 31 medications were not positively associated with increased risk of the outcomes examined. With caution, these medications warrant potential for inclusion of pregnant individuals in future studies, while drugs found to be associated with pregnancy outcomes require further investigation. MWAS facilitates hypothesis-driven evaluation of drug safety across all prescription medications, revealing potential drug candidates for further research.


Assuntos
COVID-19 , Nascimento Prematuro , Medicamentos sob Prescrição , Humanos , Recém-Nascido , Gravidez , Feminino , Resultado da Gravidez/epidemiologia , Pandemias , COVID-19/epidemiologia , Estudos Retrospectivos , Cesárea , Nascimento Prematuro/tratamento farmacológico , Medicamentos sob Prescrição/efeitos adversos , Prescrições
11.
Medicine (Baltimore) ; 101(44): e31436, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343087

RESUMO

BACKGROUND: Multiple studies have revealed that Traditional Chinese Medicine (TCM) prescriptions can provide protective effect on the cardiovascular system, increase the heart rate and relieve the symptoms of patients with bradyarrhythmia. In China, the TCM treatment of bradyarrhythmia is very common, which is also an effective complementary therapy. In order to further understand the application of Chinese medicines in bradyarrhythmia, we analyzed the medication rules of TCM prescriptions for bradyarrhythmia by data mining methods based on previous clinical studies. METHODS: We searched studies reporting the clinical effect of TCM on bradyarrhythmia in the PubMed and Chinese databases China National Knowledge Infrastructure database, and estimated publication bias by risk of bias tools ROB 2. Descriptive analysis, hierarchical clustering analysis and association rule analysis based on Apriori algorithm were carried out by Microsoft Excel, SPSS Modeler, SPSS Statistics and Rstidio, respectively. Association rules, co-occurrence and clustering among Chinese medicines were found. RESULTS: A total of 48 studies were included in our study. Among the total 99 kinds of Chinese medicines, 22 high-frequency herbs were included. Four new prescriptions were obtained by hierarchical cluster analysis. 81 association rules were found based on association rule analysis, and a core prescription was intuitively based on the grouping matrix of the top 15 association rules (based on confidence level), of which Guizhi, Zhigancao, Wuweizi, Chuanxiong, Danshen, Danggui, Huangqi, Maidong, Dangshen, Rougui were the most strongly correlated herbs and in the core position. CONCLUSION: In this study, data mining strategy was applied to explore the TCM prescription for the treatment of bradyarrhythmia, and high-frequency herbs and core prescription were found. The core prescription was in line with the treatment ideas of TCM for bradyarrhythmia, which could intervene the disease from different aspects and adjust the patient's Qi, blood, Yin and Yang, so as to achieve the purpose of treatment.


Assuntos
Medicamentos de Ervas Chinesas , Medicamentos sob Prescrição , Salvia miltiorrhiza , Humanos , Medicina Tradicional Chinesa , Bradicardia/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Mineração de Dados , Prescrições
12.
AMA J Ethics ; 24(11): E1083-1090, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36342492

RESUMO

This article analyzes differences in prescription drug pricing transparency practices among 3 Organisation for Economic Co-operation and Development member nations: the United Kingdom, Germany, and Canada. Specifically, this article compares these countries' policies on list and net price disclosures and on how international reference pricing is used to evaluate merits and drawbacks of different pricing transparency approaches. Finally, the article summarizes what policymakers in the United States should learn from these comparisons.


Assuntos
Custos de Medicamentos , Medicamentos sob Prescrição , Humanos , Estados Unidos , Custos e Análise de Custo , Reino Unido , Canadá
13.
J Drugs Dermatol ; 21(11): 1191-1195, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36342733

RESUMO

The associated direct and indirect costs of acquiring acne vulgaris (acne) treatment from a clinician may prohibit some patients from doing so. Barriers to care may also influence patient preferences for treatment, and while both over-the-counter (OTC) and prescription acne treatments are efficacious, preferences for OTC or prescription acne medications are not well established. We recruited 529 adult subjects from the United States through Amazon Mechanical Turk (MTurk), and subjects were surveyed about acne, their acne treatment preferences, and any barriers to care. A total of 450 subjects passed the attention check and were included in the analysis. Of respondents who had tried both OTC and prescription treatments (n=223), more respondents reported that they preferred prescription treatments (130/223, 58.3%), compared with OTC treatments (64/223, 28.7%); or no preference (29/223, 13.0%; P=0.00001). Almost half of all respondents also stated that they experienced barriers to accessing medical care for acne treatment (192/450 42.7%); cost and transportation were the top 2 factors. Considering how common barriers are, and their everchanging nature, some patients may benefit from a discussion of alternative non-prescription acne treatments, serving as a bridge to therapy or while patients are unable to reach a medical provider. J Drugs Dermatol. 2022;21(11):1191-1195. doi:10.36849/JDD.6940.


Assuntos
Acne Vulgar , Medicamentos sob Prescrição , Adulto , Humanos , Estados Unidos , Preferência do Paciente , Acne Vulgar/diagnóstico , Acne Vulgar/tratamento farmacológico , Medicamentos sem Prescrição/uso terapêutico , Inquéritos e Questionários , Acesso aos Serviços de Saúde , Resultado do Tratamento
15.
J Int Med Res ; 50(11): 3000605221138455, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36446764

RESUMO

OBJECTIVE: Some drugs have adverse effects on glucose metabolism, but it is unknown whether prescription drugs used prior to conception influence the future risk of gestational diabetes mellitus (GDM). Our study evaluated whether the purchase of prescription drugs 6 months prior to conception was associated with the occurrence of GDM. METHODS: This cohort study enrolled women with a Finnish background who delivered between 2009 and 2015 in the city of Vantaa, Finland (N = 10,455). Data on maternal characteristics and prescription drug purchases were obtained from national health registers. The use of a unique personal identification number enabled us to combine the register data on an individual level. RESULTS: Six months prior to conception, women who had pregnancies complicated by GDM purchased more prescription drugs than women without GDM (1.38 ± 2.04 vs. 1.11 ± 1.80). The GDM risk was higher in women with higher numbers of prescription purchases and those with more than three deliveries. CONCLUSIONS: Multiparous women who purchase several prescription drugs should be given personalized counseling to prevent GDM.


Assuntos
Diabetes Gestacional , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Medicamentos sob Prescrição , Gravidez , Feminino , Humanos , Diabetes Gestacional/tratamento farmacológico , Diabetes Gestacional/epidemiologia , Medicamentos sob Prescrição/efeitos adversos , Estudos de Coortes , Paridade
16.
BMC Geriatr ; 22(1): 824, 2022 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-36289455

RESUMO

BACKGROUND: Benzodiazepines (BZD) are widely prescribed to older adults despite their association with increased fall injury. Our aim is to better characterize risk-elevating factors among those prescribed BZD. METHODS: A retrospective cohort study using a 20% sample of Medicare beneficiaries with Part D prescription drug coverage. Patients with a BZD prescription ("index") between 1 April 2016 and 31 December 2017 contributed to incident (n=379,273) and continuing (n=509,634) cohorts based on prescriptions during a 6-month pre-index baseline. Exposures were index BZD average daily dose and days prescribed; baseline BZD medication possession ratio (MPR) (for the continuing cohort); and co-prescribed central nervous system-active medications. Outcome was a treated fall-related injury within 30 days post-index BZD, examined using Cox proportional hazards adjusting for demographic and clinical covariates and the dose prescribed. RESULTS: Among incident and continuing cohorts, 0.9% and 0.7% experienced fall injury within 30 days of index. In both cohorts, injury risk was elevated immediately post-index among those prescribed the lowest quantity: e.g., for <14-day fill (ref: 14-30 days) in the incident cohort, risk was 37% higher the 10 days post-fill (adjusted hazard ratio [HR] 1.37 [95% confidence interval [CI] 1.19-1.59]). Risk was elevated immediately post-index for continuing users with low baseline BZD exposure (e.g., for MPR <0.5 [ref: MPR 0.5-1], HR during days 1-10 was 1.23 [CI 1.08-1.39]). Concurrent antipsychotics and opioids were associated with elevated injury risk in both cohorts (e.g., incident HRs 1.21 [CI 1.03-1.40] and 1.22 [CI 1.07-1.40], respectively; continuing HRs 1.23 [1.10-1.37] and 1.21 [1.11-1.33]). CONCLUSIONS: Low baseline BZD exposure and a small index prescription were associated with higher fall injury risk immediately after a BZD fill. Concurrent exposure to antipsychotics and opioids were associated with elevated short-term risk for both incident and continuing cohorts.


Assuntos
Antipsicóticos , Medicamentos sob Prescrição , Humanos , Idoso , Estados Unidos/epidemiologia , Benzodiazepinas/efeitos adversos , Analgésicos Opioides , Estudos de Coortes , Estudos Retrospectivos , Medicare , Prescrições
17.
Health Res Policy Syst ; 20(1): 106, 2022 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-36209085

RESUMO

The economic downfall in Lebanon and the destruction of the Beirut Port have had a crippling effect on all players in the health sector, including hospitals, healthcare providers, and the pharmaceutical and medical supply industry. The outbreak of COVID-19 has further aggravated the crisis. To address the challenges facing the pharmaceutical industry, Lebanon must create a stable and secure source of prescription drug production. Two alternative approaches are presented to address the crisis: (1) amending the subsidy system and supporting local pharmaceutical production, and (2) promoting the prescription and use of generic drugs. Investing in local production is promising and can lead to establishing trust in the quality of drugs produced locally. These efforts can be complemented by promoting the prescription and use of generic drugs at a later stage, after having had established a well-operating system for local drug production.


Assuntos
COVID-19 , Medicamentos sob Prescrição , Medicamentos Genéricos , Humanos , Líbano , Políticas , Prescrições
18.
JAMA ; 328(15): 1515-1522, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36255428

RESUMO

Importance: Prescription drug spending is a topic of increased interest to the public and policymakers. However, prior assessments have been limited by focusing on retail spending (Part D-covered drugs), omitting clinician-administered (Part B-covered) drug spending, or focusing on all fee-for-service Medicare beneficiaries, regardless of their enrollment into prescription drug coverage. Objective: To estimate the proportion of health care spending contributed by prescription drugs and to assess spending for retail and clinician-administered prescriptions. Design, Setting, and Participants: Descriptive, serial, cross-sectional analysis of a 20% random sample of fee-for-service Medicare beneficiaries in the United States from 2008 to 2019 who were continuously enrolled in Parts A (hospital), B (medical), and D (prescription drug) benefits, and not in Medicare Advantage. Exposure: Calendar year. Main Outcomes and Measures: Net spending on retail (Part D-covered) and clinician-administered (Part B-covered) prescription drugs; prescription drug spending (spending on Part B-covered and Part D-covered drugs) as a percentage of total per-capita health care spending. Measures were adjusted for inflation and for postsale rebates (for Part D-covered drugs). Results: There were 3 201 284 beneficiaries enrolled in Parts A, B, and D in 2008 and 4 502 718 in 2019. In 2019, beneficiaries had a mean (SD) age of 71.7 (12.0) years, documented sex was female for 57.7%, and 69.5% had no low-income subsidies. Total per-capita spending was $16 345 in 2008 and $20 117 in 2019. Comparing 2008 with 2019, per-capita Part A spending was $7106 (95% CI, $7084-$7128) vs $7120 (95% CI, $7098-$7141), Part B drug spending was $720 (95% CI, $713-$728) vs $1641 (95% CI, $1629-$1653), Part B nondrug spending was $5113 (95% CI, $5105-$5122) vs $6702 (95% CI, $6692-$6712), and Part D net spending was $3122 (95% CI, $3117-$3127) vs $3477 (95% CI, $3466-$3489). The proportion of total annual spending attributed to prescription drugs increased from 24.0% in 2008 to 27.2% in 2019, net of estimated rebates and discounts. Conclusions and Relevance: In 2019, spending on prescription drugs represented approximately 27% of total spending among fee-for-service Medicare beneficiaries enrolled in Part D, even after accounting for postsale rebates.


Assuntos
Planos de Pagamento por Serviço Prestado , Gastos em Saúde , Medicare , Medicamentos sob Prescrição , Idoso , Feminino , Humanos , Estudos Transversais , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/tendências , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Medicare/economia , Medicare/estatística & dados numéricos , Medicare/tendências , Medicare Part D/economia , Medicare Part D/estatística & dados numéricos , Medicare Part D/tendências , Medicamentos sob Prescrição/economia , Estados Unidos/epidemiologia , Medicare Part A/economia , Medicare Part A/estatística & dados numéricos , Medicare Part A/tendências , Medicare Part B/economia , Medicare Part B/estatística & dados numéricos , Medicare Part B/tendências , Masculino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais
19.
J Nurs Adm ; 52(11): 591-597, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36252057

RESUMO

OBJECTIVE: This study examined the association between workplace exposure and prescription drug misuse in nurses. BACKGROUND: Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse. METHODS: Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression. RESULTS: Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse ( P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index. CONCLUSIONS: Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias , Humanos , Local de Trabalho , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários
20.
Am J Manag Care ; 28(10): e363-e369, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36252176

RESUMO

OBJECTIVES: To assess the accuracy of a real-time benefit tool (RTBT) that is compliant with the standards of the National Council for Prescription Drug Programs (NCPDP) in a large academic medical center. STUDY DESIGN: Observational study of electronic health records and pharmacy records from July 14, 2019, through January 14, 2020, across all ambulatory clinics and outpatient pharmacies in the health system. METHODS: Main assessments included (1) demographic characteristics of patients in whom the RTBT was used and those in whom it was not used, (2) types of changes most frequently made to medication orders upon reviewing the RTBT, and (3) comparison of the out-of-pocket costs for prescriptions vs the RTBT-generated estimates. RESULTS: The most common modifications made to prescriptions due to RTBT use were changes in days' supply (44%) and the quantity of medication (69%). In more than 98% of prescription orders, patients' out-of-pocket costs were either equivalent to or lower than the estimates generated by the RTBT. CONCLUSIONS: Current standards established by NCPDP yield accurate patient out-of-pocket estimates and could serve as a national standard for all Part D sponsors.


Assuntos
Assistência Farmacêutica , Farmácias , Farmácia , Medicamentos sob Prescrição , Humanos , Seguro de Serviços Farmacêuticos
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