Evaluation of Patient Assistance Program Eligibility and Availability for Top 200 Brand Name and Generic Drugs in the United States

One strategy to encourage uninsured and underinsured patients' compliance with medication regimen is to refer them to pharmaceutical industry-sponsored patient assistance programs (PAPs). In order to receive the requested medications, patients should be qualified based on the program eligibility requirements. The purpose of this study was to examine PAP eligibility criteria for the most commonly dispensed prescriptions in the United States. We identified 136 unique chemical entities in the Top 200 drug list and 111 (82%) of these pharmaceutical products were offered by PAPs. Among the available medications, 69 (62%) were brand name; 29 (26%) were generic, and 13 (12%) had both brand name/generic forms. In terms of the availability of types of drugs (brand name vs. generic) provided by PAPs, differences in PAP eligibility requirements were found for citizenship (p < 0.001), permanent residency (p < 0.001), and prescription drug coverage (p< 0.001), but not for income limits (p= 0.051). Overall, PAPs could help low-income patients to obtain necessary medications; however, U.S. citizenship/permanent residency and restriction on prescription coverage are more likely to be required for brand name drugs rather than for generics. PAPs also provide some options for the underinsured and those with private insurance or Medicare Part D plan that offers inadequate prescription coverage.   Type: Original Researc

Does the use of home blood pressure monitoring vary by race, education, and income?

OBJECTIVE: Home blood pressure (BP) monitors are commonly recommended for patients with hypertension, but little is known about their utilizations among different racial/ethnic groups. The objective of this study was to investigate if racial differences existed in the utilization of home BP monitoring devices. DESIGN: A voluntary and self-administered survey study. SETTING: Community pharmacies in the Greater Houston metropolitan areas, Texas, United States. PARTICIPANTS: Subjects were recruited from community pharmacies if they were aged > or = 18 years and received a prescription drug for hypertension. INTERVENTIONS: Each participant was given informed consent to complete a survey that consisted of questions about patient demographics and BP self-monitoring behavior. MAIN OUTCOME MEASURES: The primary measures were the use of home BP monitors and the patient's knowledge of BP monitoring. RESULTS: A total of 987 pharmacy customers were approached, of whom 834 patients agreed to participate (34.3% African Americans, 33.3% Whites, and 28.9% Hispanics). We found no association between race and BP monitor utilization. Patients with less education and lower income were associated with lesser use of BP monitors (P=.04 and P<.01 respectively). Patients with higher education and higher incomes were more knowledgeable about how to monitor BP at home. (P<.01). CONCLUSION: This study found that the utilization of BP monitors was not different among races. Patients with lower education level and less income were associated with less home BP monitor use. Further studies to investigate the adherence to home BP monitor use and intervention to overcome barriers to self-monitoring is needed

Evaluation of Rational Use of Medications in the United States

Rational medication use means taking medication appropriately for curing and relieving the symptoms of disease on the basis of evidence and sound judgment. We compare US policy experience on rational use of medications with the World Health Organization (WHO) list of interventions designed to promote such use. Current US performance and educational, managerial, and regulatory interventions to improve it are discussed. We conclude that, while most of the WHO guidelines for rational medication use are practiced in some form in one or more of the various US health care subsystems today, overall performance based on outcomes is not comparable with that of other industrialized countries. This is due to the absence of a national drug policy, the presence of a few strong stakeholders with committed policy preferences, and the altogether fragmented character of the US state and federal health systems. Practical suggestions are offered as to how the US could improve its overall less-than-optimal policies on rational medication use

Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group

AbstractObjectivesTo systematically review the evidence on the impact of interventions to improve medication adherence in adults prescribed antihypertensive medications.MethodsAn electronic search was undertaken of articles published between 1979 and 2009, without language restriction, that focused on interventions to improve antihypertensive medication adherence among patients (≥18 years) with essential hypertension. Studies must have measured adherence as an outcome of the intervention. We followed standard guidelines for the conduct and reporting of the review and conducted a narrative synthesis of reported data.ResultsNinety-seven articles were identified for inclusion; 35 (35 of 97, 36.1%) examined interventions to directly improve medication adherence, and the majority (58 of 97, 59.8%) were randomized controlled trials. Thirty-four (34 of 97, 35.1%) studies reported a statistically significant improvement in medication adherence.Discussion/ConclusionsInterventions aimed at improving patients’ knowledge of medications possess the greatest potential clinical value in improving adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated adherence measures, well-designed randomized controlled trials with relevant adherence and clinical outcomes, and guidelines on the appropriate design and analysis of adherence research