MedicalResearch.com Interview with:
Jonathan H. Watanabe, PharmD, PhD, BCGP
Associate Professor of Clinical Pharmacy
National Academy of Medicine Anniversary Fellow in Pharmacy
Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego
La Jolla, CA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As a clinician in older adult care and as a health economist, I’ve been following the news and research studies on older patients unable to pay for their medications and consequently not getting the treatment they require. Our goal was to measure how spending on the medications Part D spends the most on, has been increasing over time and to figure out what prices patients are facing out-of-pocket to get these medications.
In 2015 US dollars, Medicare Part D spent on the ten highest spend medications increased from $21.5 billion in 2011 to $28.4 billion in 2015. The number of patients that received one of the ten highest spend medications dropped from 12,913,003 in 2011 to 8,818,471— a 32% drop in that period.
A trend of spending more tax dollars on fewer patients already presents societal challenges, but more troubling is that older adults are spending much more of their own money out-of-pocket on these medications. For patients without a federal low income subsidy, the average out-of-pocket cost share for one of the ten highest spend medications increased from $375 in 2011 to $1,366 in 2015. This represented a 264% increase and an average 66% increase per year. For patients receiving the low income subsidy, the average out-of-pocket cost share grew from $29 in 2011 to $44 in 2015 an increase of 51% and an average increase of 12.7% per year. This may not sound like much, but for those living close to the federal poverty level this can be the difference between foregoing necessities to afford your medications or choosing not to take your medications.
MedicalResearch.com: What should readers take away from your report?
Response: From a US public health stand point with a rapidly aging population, we need to understand and come to terms with the societal impact of spending the amount we are on medications and the inordinate pressure it places on older adults, most on fixed incomes, to pay for medication prices at a level they never expected.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We describe in the paper, the need for improved systematic and evidence-based review that incorporates cost to guide medication usage that makes sense for the actual patient. Much more effort needs to be expended in understanding the challenges skyrocketing prices are having on patients and health systems particularly for those that serve vulnerable populations. Prior publications have described the need for better dialogue between prescribers and pharmacists to determine medications that make the most sense for the individual patient. Studies of these efforts should be accelerated.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is critical that the public understands what is taking place, so they can participate in the dialogue and decision-making to determine as a society how health care should be administered. This is ultimately their tax dollars that pay for it. Our system for medication use and health delivery is incredibly complex. We need to make it more transparent and empower the public to help shape it.
I have nothing to disclose.
Jonathan H. Watanabe, Diane L. Chau, Jan D. Hirsch. Federal and Individual Spending on the 10 Costliest Medications in Medicare Part D from 2011 to 2015. Journal of the American Geriatrics Society, 2018; DOI: 10.1111/jgs.15443
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