Entries in Surveys & Reports (99)


Patients Happy With PCPs But Not Always Following Their Advice Due to Costs

By Clive Riddle, May 19, 2016

The Physicians Foundation has just released a 74-page report with results from their Physicians Foundation Patient Survey conducted by Harris Poll. The report findings state that “95 percent of patients surveyed are satisfied or very satisfied with their PCP’s ability to explain information in a manner they understand, while 96 percent feel their physicians are respectful of them. Moreover, 93 percent were satisfied or very satisfied with how well their PCP listened to them during their most recent exam, with 92 percent noting high levels of satisfaction relative to how well their doctor knew their medical history.”

But the report notes that “patients who saw a primary care physician for their most recent routine exam are not fully adhering to treatment plans, avoiding routine check-ups or opting not to take prescription medication due to rising healthcare costs.”

They cite that “ sixty-two percent of U.S. adults are concerned with being able to pay for medical treatment if they get sick or injured. Almost half (48 percent) are not confident they could afford care should they become seriously ill. In addition, more than a quarter of U.S. adults (28 percent) have skipped a medical test, treatment or follow-up or avoided a visit to the doctor for a medical problem in the past 12 months because of costs. Twenty-seven percent of patients have avoided filling a prescription in the past 12 months, noting costs as a primary factor.”

Who do patients feel are driving these costs? The report says that “59 percent of patients surveyed say it’s the cost of prescription drugs. One-third (33 percent) of patients cited fraud as another contributor factor, followed by social conditions and poverty (28 percent), government mandates (26 percent) and an aging population (25 percent).”

Rip Hollister, MD, a Physicians Foundation board member tells us “patients recognize that there is an array of stakeholders and external influences that affect treatment options and, in effect, clinical autonomy. Historically, treatment plans have been developed between the doctor and patient. Yet, patients understand that there are now many other parties ‘in the room,’ so to speak, which complicates and challenges the manner in which physicians practice medicine.”

In this regard, the report cites how much patients felt each of the following stakeholder groups, as a whole, impacts treatment options available to them:

  • Health insurance companies (83 percent)
  • Physicians (79 percent)
  • Pharmaceutical companies (68 percent)
  • Federal legislature (60 percent)
  • State legislatures (54 percent)

The Biosimilar Opportunity

By Clive Riddle, April 1, 2016

Biosimilars hold considerable future opportunity for helping address rapidly rising prescription costs. They also hold considerable opportunity for pharmaceutical companies seeking to offer them, as well as challenges for pharmaceutical holders of brand drugs that they would impact.

PwC listed Biosimilars as one of their top ten health industry issues of 2016. They stated that “Finally entering the US market, biosimilar drugs have the potential to be as disruptive as generic drugs following the Hatch-Waxman Act of 1984. The first US biosimilar - Sandoz’s Zarxio, which prevents infections in cancer patients – received FDA approval in 2015, and entered the market at a 15% discount. At least four biosimilar applications are pending FDA review in 2016, with another 50 in the FDA review process.”

PwC also another challenge in that U.S> consumers don’t know what the heck a Biosimilar is: citing a survey in which only 17% of consumers chose a correct definition of Biosimilar when offered multiple choice answers.

Biosimilars are of course much further along the path in Europe, but in addition to consumer confusion and provider and purchaser lack of familiarity as well, there is of course continued regulatory morass as well as lobbying from pharmaceutical companies trying to protect specific brand drug turf. The NCSL (National Conference of State Legislatures) has a page dedicated to the topic of State Laws and Legislation Related to Biologic Medications and Substitution of BioSimilars.

In addition to monitoring and summarizing this activity, NCSL provides easy to understand background information. They tell us “Biologic medicines are much more complex than traditional chemically synthesized drugs. Biologics are manufactured from living organisms by programming cell lines to produce the desired therapeutic substances and consist of large molecules….Regulating biologics raises new issues for both state and federal policymakers. Because of their complexity, biologic drugs are much more difficult to replicate than the chemically produced generics for other drugs. The cell lines used and modifications in the manufacturing process affect biologic medicines. As a result, truly identical “generic” versions are currently virtually impossible to produce. However, once patents expire for the existing brand-name biologic drugs, “biosimilar” medicines can be produced, which is an occurrence that raises regulatory issues in the states. Currently, there is concern that traditional statutes regulating ‘generic drugs’ may be misapplied to new products that are not identical. This has led to a recent move to amend older state laws to address the medical and chemical characteristics of these ‘biologics,’ as well as any future generic-style ‘follow-on biologics’ or ‘biosimilars.’ “

This week the IMS Institute for Healthcare Informatics released a 36 page report: Delivering on the Potential of Biosimilar Medicines -The Role of Functioning Competitive Markets, telling us that “Greater acceptance of biosimilar medicines in a growing number of therapy areas and an active pipeline of 56 new products in clinical development are expected to deliver total savings of as much as $110 billion to health systems across Europe and the U.S. through 2020.”

IMS offer considerable research into Biosimilar adoption and issues in Europe, and counsels that “As these medicines also become available in the U.S., stakeholder education and incentives will play a vital role in ensuring biosimilars deliver their full potential.” Their report finding include:

  • Considerable variations across the EU in payer policy approaches are limiting the biosimilar opportunity.
  • Biosimilars use in the EU and U.S. may yield total savings of $56-110 billion over the next five years.
  • Patient access to biologic treatments has grown by as much as 100 percent following the availability of biosimilars.
  • Intensifying competition and greater choice are expected as new biosimilars reach the market.
  • Capturing the benefits of biosimilar medicines requires a balance between controlling price and ensuring a sustainable, competitive marketplace.

IMS emphasizes the need for education and incentivization in order for Biosimilars to fulfill their potential.  They tell us that “Payers need to ensure that they are keeping themselves informed. The variation in policies adopted, as well as in biosimilar prices and uptake, across the EU, suggests that some payers do not understand the potential offered by biosimilar medicines. Physicians need to trust that biosimilar medicines offer a safe and efficacious alternative to original biologics…..Patients are expected to accept new technologies, about which they may have only limited information….Payers need to ensure that doctors see a tangible benefit to prescribing biosimilar medicines. Physicians need to understand that prescribing biosimilar products delivers clinical benefits across the market as a whole, and that the cost-savings that result from biosimilar uptake enable more patients to access needed treatment.”


Medication Adherence and Out of Pocket Costs

By Clive Riddle, March 25, 2016

While out of pocket costs impact consumer demand and utilization for healthcare services in various degrees for all aspects of care, the relationship is perhaps the most direct for prescriptions. This direct relationship is due to both the relatively lower average cost per prescription compared to the per unit cost of most other health care services, along with the behavioral economics implications that a prescription typically delivers delayed results, while most other healthcare services provide perceived potentially immediate results.

In this context, Truveris, a pharmacy benefits solutions provider, has just released study results examining medication adherence based upon out of pocket prescription costs. They found that “85 percent of prescriptions are filled when the price at the register is around $30. Once the cost of a prescription surpasses $50, the rate starts a notable decline, dropping to 76 percent. The number of prescriptions filled drops even further, to 65 percent, when the cost is $90 and above.”

Kristin Begley, Chief Pharmacy Officer at Truveris tells us “as healthcare costs continue to burden Americans, there is ample evidence of increased prescription costs leading to discontinuation of medications in order to save money. We’re seeing a troubling trend that when drug prices reach a certain level, consumers are simply walking away, not filling the prescriptions and, in effect, gambling on their health. This should be an urgent wake-up call across the healthcare spectrum.”

Taking things a step further, a Geisinger study published in the February 2016 issue of The American Journal of Managed Care “shows that instituting a zero prescription co-pay for its chronically ill employee population resulted in a positive cost saving and return on investment.”

The Geisinger study found “that a zero co-pay drug program for its chronically ill employee population was associated with positive cost savings and a return on investment of 1.8 over five years….More than 200 prescription medications were selected to be eligible for the $0 co-pay program; those selected were designated for chronic conditions like high blood pressure, cholesterol and diabetes management and were preventative in nature. Geisinger researchers say that VBID implementation within the context of a wider employee wellness program targeting the appropriate population can potentially lead to further positive cost savings.”


Under the Influence

By Kim Bellard, March 18, 2016

new analysis by ProPublica found that doctors who receive money from drug companies do, in fact, tend to prescribe more brand name drugs, and that the more money they got, the more brand name prescribing they did.

ProPublica looked at prescribing patterns from five specialties -- cardiovascular, family medicine, internal medicine, ophthalmology, and psychiatry -- with the restriction that individual physicians had to have had at least 1,000 Part D prescriptions in the study period (2014).  Overall, about three-fourths of physicians took some money from a drug company, although there was wide variation by specialty and geography -- e.g., nearly 9 of 10 cardiologists took payments, just as around 90% of physicians took such payments in Nevada, Kentucky, Alabama, and South Carolina. 

Conversely, in Minnesota and Vermont the percentage was closer to 25%.

The amount of the payments appeared to have an impact.  Internists who received no payments had brand-name prescribing rates of about 20%, while those getting more than $5,000 had rates of around 30%.

The defenses from physician organizations and the drug industry make for fun reading.  Dr. Richard Baron, the president and chief executive of the America Board of Internal Medicine, protested that doctors almost have to go out of their way to avoid taking these kinds of payments.

The president of the American College of Cardiology suggested the patterns were re-enforcing; the more they learn about a drug, the more they tend to use it, and the more they use it, the more drug companies pay them to be speakers and consultants.

Seriously, these are their defenses?

We've been learning a lot more about how pervasive industry payments -- not just pharmaceutical companies but also medical device and other health care suppliers -- are since the advent of the Open Payments initiative.  We're talking about over $6.5b in payments in 2014, made to over 600,000 physicians and 1100 hospitals.  I wrote about this last summer, and the new ProPublica analysis certainly should rattle any remaining doubts anyone might have had about the potential impact of such payments. 

True to form, last fall the AMA called for a ban on DTC advertising.   That's right, they don't seem disturbed about the $6.5b physicians are getting, but they think that the ads that we see are bad.  There's a certain logic to that; it has long been suspected that these ads help drive consumer demand.

Austin Frakt, of The New York Timesrecently challenged this conventional wisdom.  For one thing, he notes that while drug ads do cause an increase in sales for the advertised drug, they also increase sales of other drugs in the same class, using Prozac as an example.  Seeing drug ads may help "normalize" the condition being treated, making getting treatment for it more acceptable, and may also help encourage patients to continue with existing prescriptions.  

Mr. Frakt points out that it is not only the drug companies who benefit from drug advertising, but also physicians.  Every $28 in drug advertising results in an additional doctor visit; someone has to do the prescribing, after all.  And, of course, the DTC spending is dwarfed by the direct-to-physician "promotions" -- Mr. Frakt estimates drug companies spend seven times more on these than on DTC advertising. 

So we're back to the ProPublica analysis. 

It simply is not plausible to maintain that these efforts are not influencing physicians' decisions, and that they may not always be in the best interests of patients.  As Bloomberg put it last summer: the payments "seek to convince doctors that second choice is OK."
Well, I don't know about you, but that is not OK with me. 

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


Retail Clinics: Trying to Reconcile Cost Per Visit, Utilization, Access and Convenience

By Clive Riddle, March 10, 2016

The March issue of Health Affairs features a paper presenting study findings on retail clinic:  Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending. The title would seem to say it all regarding their findings. The study involved retail clinic use by 3 million Aetna members, from 2010 to 2012 for 11 low-acuity conditions. 

Here’s what the authors had to say in part in their abstract: “We found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.”

Kaiser Health News, in covering the story, notes that “The study doesn’t contradict earlier research that found retail clinics provide care that costs 30 to 40 percent less than similar care provided at a physician’s office and that the treatment for routine illnesses was of similar quality. But it suggests those savings are more than offset by increased use of medical services.”

But for some who embrace this perspective, but also are critics of increased consumer cost-sharing including high deductible plans that can limit access, is this perhaps a bit contradictory from a policy standpoint? If you are concerned the increased access and use of such services drives up costs, should you be concerned about cost savings measures that decrease potential access and use?

Interestingly, a Policy Brief in last month’s Health Affairs  on High Deductible Health Plans features the lead-in: “As high-deductible health plans become increasingly prevalent in both group and individual markets, it remains to be seen how they will affect health care access and outcomes.”

Is it a paradox that high-deductible health plan consumers are target audiences for retail care clinics?

Last month, NPR, Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health released the 42-page study: Patients’ Perspectives on Health Care in the United States which addressed retail clinic and urgent care use among many things. 92% of survey respondents rated retail clinic costs as reasonable, and 74% rated urgent care costs as reasonable, compared to 77% rating their personal doctor visit costs as reasonable and 58% rating emergency room costs as reasonable.

Granted, the study published in Health Affairs didn’t dispute the lower cost per visit – they just conclude that the retail supply creates demand and thus drives up costs. But what about access, and what happens to overall costs when access isn’t adequate? Isn’t that the critique of high deductible plans – that high out of pocket costs become a barrier to access?

The argument put forth in Health Affairs is your out of pocket costs might be higher per visit, but ultimately lower overall, by always sticking with your personal doctor because you will see them less.

And see them less you very well may. Another aspect of access addressed in the NPR study: 22% said they could not see their regular doctor at some point in the past two years when they needed health care, with the number one reason the doctor did not have any available appointment times (followed by care was needed at night or on the weekend.)