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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 12 of 12 Research Studies DisplayedDing Y, Miller GE
AHRQ Author: Ding Y, Miller GE
The impact of sharing drug rebates at the point of sale on out-of-pocket payments for enrollees in employer-sponsored insurance.
The purpose of this study was to estimate the effect of sharing drug rebates at the point of sale on out-of-pocket spending by connecting estimated rebates to administrative claims data for employer-sponsored insurance enrollees in 2018. The researchers utilized the drug rebate rate with the retail price of each brand name drug fill, and the reductions were allocated to out-of-pocket spending based on cost-sharing provisions. Individual out-of-pocket spending was aggregated across drug fills. It was assumed that generic drugs have no rebates for employer-sponsored insurance. The impact of sharing rebates at the point of sale on out-of-pocket spending overall, for therapeutic classes and specific drugs with the highest average out-of-pocket spending per user, and by health plan type was assessed. The study found that across four simulations with different assumptions about cross-fill effects, 10.4% to 12.2% of enrollees in the sample would have realized savings on out-of-pocket spending if rebates were shared at the point of sale. Among those with savings, approximately half would save $50 or less, and 10% would save more than $500 annually. A premium increase of $1.06 to $1.41 per member per month among the continuously enrolled, insured population would be sufficient to finance the out-of-pocket savings in the sample.
AHRQ-authored.
Citation: Ding Y, Miller GE .
The impact of sharing drug rebates at the point of sale on out-of-pocket payments for enrollees in employer-sponsored insurance.
Value Health 2023 Feb; 26(2):226-33. doi: 10.1016/j.jval.2022.08.001..
Keywords: Health Insurance, Medication
Hill SC, Miller GE, Ding Y
AHRQ Author: Hill SC, Miller GE, Ding Y
Net spending on retail specialty drugs grew rapidly, especially for private insurance and Medicare Part D.
This study examined net spending trends on retail specialty drugs from 2010 to 2017. Spending has been difficult to measure due to proprietary rebate payments by manufacturers by insurers, pharmacy benefit managers and state Medicaid agencies. The authors incorporated those rebates into their research. They found that specialty drugs accounted for 37.7% of retail and mail-order prescription spending net of rebates in 2016-17. The spending net of rebates tripled for Medicare Part D beneficiaries and more than doubled for people with private insurance from 2010 to 2017. Medicaid net spending of rebates had a slower increase.
AHRQ-authored.
Citation: Hill SC, Miller GE, Ding Y .
Net spending on retail specialty drugs grew rapidly, especially for private insurance and Medicare Part D.
Health Aff 2020 Nov;39(11):1970-76. doi: 10.1377/hlthaff.2019.01830..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Medication, Medicare, Health Insurance
Maclean JC, Halpern MT, Hill SC
AHRQ Author: Hill SC
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
The purpose of this study was to quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data from the Medicaid State Drug Utilization Database was used. Findings showed that Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.
AHRQ-authored.
Citation: Maclean JC, Halpern MT, Hill SC .
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
Health Serv Res 2020 Jun;55(3):399-410. doi: 10.1111/1475-6773.13289..
Keywords: Medicaid, Cancer: Breast Cancer, Cancer, Medication, Policy, Women, Healthcare Utilization, Access to Care, Health Insurance
Bailey SR, Marino M, Ezekiel-Herrera D
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
This study examined whether states that expanded Medicaid eligibility under the ACA had increased smoking quit rates, tobacco cessation medication orders, and greater health care utilization compared to patients in non-expansion states. The researchers used electronic health record (EHR) data from 219 community health centers (CHCs) in 10 states that expanded Medicaid as of January 2014. They identified patients aged 19-64 with tobacco use status in their records within six months prior to ACA Medicaid expansion and 1 or more visits. They found that patients in expansion states had increased adjusted odds of quitting, having a medication ordered and having follow-up visits compared to patients in non-expansion states.
AHRQ-funded; HS024270.
Citation: Bailey SR, Marino M, Ezekiel-Herrera D .
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
Nicotine Tob Res 2020 Jun;22(6):1016-22. doi: 10.1093/ntr/ntz087..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse, Medication, Medicaid, Policy, Healthcare Utilization, Access to Care, Health Insurance
Kayle M, Valle J, Paulukonis S
Impact of Medicaid expansion on access and healthcare among individuals with sickle cell disease.
The purpose of this study was to examine whether Medicaid expansion in California, increased Medicaid enrollment, increased hydroxyurea prescriptions filled, and decreased acute healthcare utilization in sickle cell disease (SCD). Findings showed that Medicaid expansion did not appear to have improved enrollment or acute healthcare utilization among individuals with SCD in California. Recommendations included future studies exploring whether individuals with SCD transitioned to other insurance plans or became uninsured post-expansion, the underlying reasons for low hydroxyurea utilization, and the lack of effect on hospital admissions despite a modest effect on emergency department visits.
AHRQ-funded; HS023011; HS025297.
Citation: Kayle M, Valle J, Paulukonis S .
Impact of Medicaid expansion on access and healthcare among individuals with sickle cell disease.
Pediatr Blood Cancer 2020 May;67(5):e28152. doi: 10.1002/pbc.28152..
Keywords: Sickle Cell Disease, Medicaid, Access to Care, Healthcare Utilization, Medication, Hospitalization, Health Insurance
Tseng CW, Masuda C, Chen R
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
In this study, the investigators examined how patients’ out-of-pocket costs for insulin would have dropped from 2014 to 2019 due to Part D policy changes and whether higher insulin prices offset these potential savings. The authors concluded that efforts to reduce patients’
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
AHRQ-funded; HS024227.
Citation: Tseng CW, Masuda C, Chen R .
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
Diabetes Care 2020 Apr;43(4):e50-e51. doi: 10.2337/dc19-1294..
Keywords: Medication, Healthcare Costs, Medicare, Health Insurance, Policy
Mackie TI, Cook S, Crystal S
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
This study examined a multimodal antipsychotic intervention implemented by a specialized Medicaid managed care organization (MMCO) for youths in foster care with routine mental health screening, health passports, elective psychiatric consultation line, and retrospective drug utilization reviews to determine whether this multimodal intervention significantly reduced antipsychotic dispensing for youths with conditions without US Food and Drug Administration (FDA)-approved indications. Findings showed that MMCO implementation significantly reduced antipsychotic medications without FDA-indicated conditions prescribed to youths, while not significantly affecting antipsychotic medications prescribed to youths with FDA-indicated conditions.
AHRQ-funded; HS026001.
Citation: Mackie TI, Cook S, Crystal S .
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
J Am Acad Child Adolesc Psychiatry 2020 Jan;59(1):166-76.e3. doi: 10.1016/j.jaac.2019.04.022..
Keywords: Children/Adolescents, Behavioral Health, Medication, Vulnerable Populations, Medicaid, Health Insurance
Zhang Y, Johnson P, Jeng PJ
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
This study examined the association between a first opioid prescription and high-risk opioid use in the 18 months following the first prescription. A retrospective cohort study was conducted using data from a large commercial insurance claims database for patients aged 18-64 and also Medicare Advantage patients aged 65 or older for 2011-2014. The patients initially had not used opioids. The features the researchers were looking for were: 1) opioid or benzodiazepine prescriptions overlapping 7 days or more, 2) opioid prescriptions overlapping for 7 days or more; 3) three or more prescribers of opioids; and 4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. All of those features were strongly associated with high-risk use.
AHRQ-funded; HS021531.
Citation: Zhang Y, Johnson P, Jeng PJ .
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
J Gen Intern Med 2018 Dec;33(12):2156-62. doi: 10.1007/s11606-018-4628-y..
Keywords: Opioids, Substance Abuse, Medication, Risk, Medicare, Health Insurance
Yazdany J, Dudley RA, Lin GA
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
This paper discusses the out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D. The investigators analyzed nationwide benefit design data for all Part D plans from the June 2017 Medicare Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files to calculate mean total cost and out-of-pocket cost requirements for infliximab-dyyb and infliximab assuming a standard 8-week dosing regimen.
AHRQ-funded; HS016772.
Citation: Yazdany J, Dudley RA, Lin GA .
Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D.
JAMA 2018 Sep 4;320(9):931-33. doi: 10.1001/jama.2018.7316..
Keywords: Healthcare Costs, Health Insurance, Medicare, Medication, Arthritis
Karter AJ, Parker MM, Solomon MD
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
This study estimated the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index.
AHRQ-funded; HS022408.
Citation: Karter AJ, Parker MM, Solomon MD .
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
Health Serv Res 2018 Apr;53(2):1227-47. doi: 10.1111/1475-6773.12700.
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.
Keywords: Diabetes, Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Tran Smith B, Seaton K, Andrews C
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
This study assessed the extent to which state insurance departments regulate the types of substance use disorder (SUD) treatment that services and medications plans must provide, and also their use of utilization controls. Data were obtained from state insurance departments via an internet-based survey, as part of the National Drug Abuse Treatment System Survey. The results indicate that states vary widely in regulations on qualified health plans’ (QHPs) administration of SUD treatment benefits; some required plans to cover all the SUD treatment services and medications assessed in this study, while others did not require plans to cover any at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance on their usage. The authors conclude that by not requiring coverage for the entire SUD continuum of care, some states hinder client access to the appropriate types of care needed for recovery.
AHRQ-funded; HS000084.
Citation: Tran Smith B, Seaton K, Andrews C .
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
Am J Drug Alcohol Abuse 2018;44(4):426-30. doi: 10.1080/00952990.2017.111934..
Keywords: Access to Care, Health Insurance, Medication, Policy, Substance Abuse
Smieliauskas F, Sharma H, Hurley C
State insurance mandates and off-label use of chemotherapy.
In this study, the investigators hypothesized that state health insurance mandates for private insurers to provide coverage for off-label use of cancer drugs cause higher rates of off-label use. They used Truven MarketScan data from 1999 to 2007 on utilization of 35 infused chemotherapy drugs in private health plans in the United States to study trends in off-label use of drugs, distinguishing between appropriate and inappropriate off-label use according to drug compendia, and estimated difference-in-difference regressions of the effect of state laws on off-label use.
AHRQ-funded; HS018535.
Citation: Smieliauskas F, Sharma H, Hurley C .
State insurance mandates and off-label use of chemotherapy.
Health Econ 2018 Jan;27(1):e55-e70. doi: 10.1002/hec.3537.
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Keywords: Access to Care, Cancer, Treatments, Health Insurance, Medication