Specialty drugs are identified by high monthly costs and complexity of administration. Payers use utilization management strategies, including prior authorization and separate tiers with higher cost sharing, to control spending. These strategies can negatively impact patients' health outcomes through treatment initiation delays, medication abandonment, and nonadherence. To examine the effect of patient cost sharing on specialty drug utilization and the effect of prior authorization on treatment delay and specialty drug utilization. We conducted a literature search in the period between February 2021 and April 2022 using PubMed for articles published in English without restriction on date of publication. We included research papers with prior authorization and cost sharing for specialty drugs as exposure variables and specialty drug utilization as the outcome variable. Studies were reviewed by 2 independent reviewers and relevant information from eligible studies was extracted using a standardized form and approved by 2 reviewers. Review papers, opinion pieces, and projects without data were excluded. Forty-four studies were included in this review after screening and exclusions, 9 on prior authorization and 35 on cost sharing. Patients with lower cost sharing via patient support programs experienced higher adherence, fewer days to fill prescriptions, and lower discontinuation rates. Similar outcomes were noted for patients on low-income subsidy programs. Increasing cost sharing above $100 was associated with up to 75% abandonment rate for certain specialty drugs. This increased level of cost sharing was also associated with higher discontinuation rates and odds. At the same time, decreasing out-of-pocket costs increased initiation of specialty drugs. However, inconsistent results on impact of cost sharing on medication possession ratio (MPR) and proportion of days covered (PDC) were reported. Some studies reported a negative association between higher costs and MPR and PDC; however, MPR and PDC of cancer specialty drugs did not decrease with higher costs. Significant delays in prescription initiation were reported when prior authorization was needed. Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence. Similarly, programs that reduce patient cost sharing increase initiation and persistence. In contrast, cost sharing had an inconsistent and bidirectional effect on MPR and PDC. Prior authorization caused treatment delays, but its effects on specialty drug use varied. More research is needed to examine the effect of cost sharing and prior authorization on long-term health outcomes.
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http://dx.doi.org/10.18553/jmcp.2023.29.5.449 | DOI Listing |
Cogn Neurodyn
December 2024
Hebei Key Laboratory of Bioelectromagnetics and Neuroengineering, Tianjin, China.
EEG decoding plays a crucial role in the development of motor imagery brain-computer interface. Deep learning has great potential to automatically extract EEG features for end-to-end decoding. Currently, the deep learning is faced with the chanllenge of decoding from a large amount of time-variant EEG to retain a stable peroformance with different sessions.
View Article and Find Full Text PDFIr Vet J
December 2024
Centre for Veterinary Epidemiology and Risk Analysis, School of Veterinary Medicine, UCD, University College Dublin, Belfield, Dublin, D04 W6F6, Ireland.
There has been a sharp disimprovement in the bovine tuberculosis (bTB) situation in Ireland in recent years. This commentary argues for critical programme change in three overarching themes relevant to the Irish bTB eradication programme, if eradication is to be successful: (1) Limiting infection in cattle. Residual (hidden) infection is an important constraint to eradication, due to the use of imperfect diagnostic tests.
View Article and Find Full Text PDFPLOS Glob Public Health
December 2024
The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, the Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
The advent of metagenomics has dramatically expanded our understanding of microbial communities, particularly through the study of wastewater, which serves as a rich source of microbial data. In Africa, wastewater metagenomics presents unparalleled opportunities for public health monitoring, antimicrobial resistance (AMR) tracking, and the discovery of new microbial species and functions. Utilizing high-throughput sequencing (HTS) technologies, this method allows for direct analysis of nucleic acids from wastewater samples, providing a cost-effective and comprehensive approach for pathogen surveillance.
View Article and Find Full Text PDFPLoS One
December 2024
Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands.
The demographic shift has increased the demand for surgical interventions to address age-related degenerative diseases, such as spinal fusion. Accurate placement of pedicle screws, crucial for successful spinal fusion, varies widely with physician experience. Integrating tissue sensing into spine surgical instruments allows intraoperative examination of tissue properties, providing surgeons with additional information to prevent screw misplacement.
View Article and Find Full Text PDFHealth Econ Rev
December 2024
Nord University Business School, Bodø, Norway.
Background: The literature on care coordination refers to high service costs, low quality, and consumer dissatisfaction, as the consequences of institutional fragmentation and uncoordinated care.
Objectives: In this work we are concerned with the role financial incentives (reimbursement schemes) might play in promoting coordinated care when providers are organized sequentially along a care pathway and the clients (patients) are transferred from one caregiver to another.
Methods: We apply a game-theoretic framework to analyze the situation where three providers provide services to a patient group and there are interdependencies between the providers in terms of cost-externalities and altruistic patient preferences.
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