Navigation Links
Lower-cost drug substitutions could mean big savings for Medicare patients, government
Date:8/24/2013

As everyone knows, medications are expensive, and even with insurance coverage, patients' out-of-pocket drug costs can be quite hefty. This holds true for individuals with Medicare Part D, also known as the prescription drug benefit, which subsidizes the cost of medications for about 28 million Medicare beneficiaries.

About one-fifth of these Part D beneficiaries have out-of-pocket costs that top $100 a month. As a result, some 10 percent are forced to use less medication than prescribed due to financial hardship. And while the program's low-income subsidy can help reduce costs for those with the greatest need, it doesn't reduce the overall cost of medications, so the government continues picking up most of the tab.

Given that both the government and Medicare beneficiaries have to deal with the high cost of medication, there is a need for strategies to reduce those costs.

A new UCLA-led study published online in the Journal of General Internal Medicine points to a simple solution that could result in hundreds of dollars in savings per patient: Instead of brand-name drugs, substitute less expensive counterparts that have a similar therapeutic effect a practice sometimes known as therapeutic interchange or therapeutic substitution.

While this seems simple and while about 90 percent of hospitals do it all the time it is, oddly, not yet common practice in outpatient settings in the United States. 

The cost of prescription medications continues to grow each year, for patients, health plans and government insurance programs such as Medicare, said the study's lead investigator, Dr. O. Kenrik Duru, an associate professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

"The increase in prescription drug costs is not sustainable over time, and we need to consider alternative approaches that are more cost-conscious," he said. "Many patients are not aware that there is often a less expensive alternative to many popular medications that may work slightly differently but have a very similar therapeutic effect. While the appropriateness of substituting less expensive medication varies in different clinical situations, patients need to know about potential options so they can have informed discussions with their doctors."

The researchers used 2007 data to identify 50 common medications prescribed in a large Medicare Part D health plan. In addition, a group of practicing clinicians and pharmacists identified a subset of about 30 of these medications for which there was either a direct generic substitute that used the same chemical compound, or an acceptable and less expensive therapeutic substitute that used a different chemical compound with a very similar therapeutic effect. 

The researchers then compared the cost of the original medications to the substitutes and calculated the potential savings. This included savings for the patient, the health plan and, in some cases, for the government when it was subsidizing the cost.

They found that 39 percent of Medicare patients receiving the low-income subsidy and 51 percent of patients not receiving the subsidy were eligible for a generic or therapeutic substitution. (The health plans and the government pay most of the medication costs for subsidy-eligible patients.)

For each generic substitution among patients receiving a subsidy, the government would save an average of $156 per year, the researchers found. Each therapeutic substitution among subsidized patients would result in greater savings: The government would, on average, save $126 per year, and the health plan would save $305 per year.

Patients not receiving the low-income subsidy would save $138 per year for each generic substitution. For each therapeutic substitution, each patients would save, on average, $113 per year, and the health plan would save $276 per year.

The researchers noted that not every substitution is appropriate for every patient, and they acknowledged that in some clinical scenarios, potential substitutions have already been tried unsuccessfully or may not be appropriate at all. For these reasons, they listed cost-savings as a per-substitution figure rather than estimating potential savings across the entire system. (The latter number would depend on exactly how many people switched to potential substitutes.)

Also, the researchers said, these numbers are from a single health plan at one point in time and cannot be generalized to other health plans.

But, Duru noted, "The purpose of this research was to provide a general estimate of possible potential savings."


'/>"/>

Contact: Enrique Rivero
erivero@mednet.ucla.edu
310-794-2273
University of California - Los Angeles Health Sciences
Source:Eurekalert

Related medicine news :

1. Red wine, fruit compound could help block fat cell formation
2. Pulse pressure elevation could presage cerebrovascular disease in Alzheimers patients
3. Report says new evidence could tip the balance in aspirin cancer prevention care
4. Climate Change Could Be Tough on Seniors Health: Study
5. Could Menthol Cigarettes Pose Even Higher Stroke Risk?
6. Online Tool Could Diagnose Autism Quickly, Developers Say
7. Codeine After Surgery Could Endanger Certain Kids: Study
8. BMC study shows diverting passengers to elevators could help reduce falls at Logan Airport
9. Discovery could help to develop drugs for organ transplant and cancer patients
10. Feelings of immaturity accompany alcohol misuse into adulthood; discovery could improve treatments
11. Saliva test could dramatically increase detection of oral cancer
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... ... February 12, 2016 , ... Donor Network West, the ... and Nevada, announced a partnership with San Ramon Regional Medical Center. Under the collaboration, ... facilities as a way to accommodate a more certain time frame for donor families ...
(Date:2/12/2016)... ... February 12, 2016 , ... J ... communities by continuing it’s commitment to act as Agents of Change in the ... closely with area homeless families to fulfill immediate needs and help them move ...
(Date:2/12/2016)... (PRWEB) , ... February 12, 2016 , ... ... High-Cost Drug Categories: Strategies for Health Plans and PBMs,” an upcoming Feb. 24 ... maintain affordability and access in big-dollar therapeutic categories, such as the $1,000-per-pill hepatitis ...
(Date:2/12/2016)... , ... February 12, 2016 , ... A lot has ... 35 years. A president has access to health and wellness resources most Americans could ... world, no single individual has a schedule as frenetic as the U.S. President. ...
(Date:2/12/2016)... Middletown, N.J. (PRWEB) , ... February 12, 2016 ... ... Americans is creating explosive growth in the field of long term care. With ... heightened demand for well-trained healthcare professionals in administrative roles in long term care ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... FRANCISCO , Feb. 11, 2016  Kindred Biosciences, ... on saving and improving the lives of pets, today ... Section of the New Animal Drug Application (NADA) for ... pivotal field study (KB0120) of Zimeta for the control ... the Company. --> --> ...
(Date:2/11/2016)... Feb. 11, 2016  Governor Andrew M. Cuomo today ... 1,400 jobs throughout Western New York ... the SUNY Polytechnic Institute, includes a major expansion of ... Buffalo , as well as the ... in Dunkirk . The combined projects ...
(Date:2/11/2016)... SAN FRANCISCO , Feb. 11, 2016 Potrero ... system, is pleased to announce the appointment of George ... San Antonio, TX , WellMed is ... servicing over 200,000 patients and HMO members in ... founding WellMed in 1990 out of his own internal medicine ...
Breaking Medicine Technology: