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Khazanchi R, Powers S, Killelea A, Strumpf A, Horn T, Hamp A, McManus KA. Access to a novel first-line single-tablet HIV antiretroviral regimen in Affordable Care Act Marketplace plans, 2018-2020. J Pharm Policy Pract 2023; 16:57. [PMID: 37081570 PMCID: PMC10116786 DOI: 10.1186/s40545-023-00559-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND A pillar of the United States' Ending the HIV Epidemic (EHE) initiative is to rapidly provide antiretroviral therapy (ART) in order to achieve HIV viral suppression. However, insurance benefit design can impede ART access. The primary objective of this study is to understand how Affordable Care Act (ACA) Marketplace qualified health plan (QHP) formularies responded to two new ART single tablet regimens (STRs): dolutegravir/abacavir/lamivudine (DTG/ABC/3TC; approved in 2014) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF; approved in 2018). METHODS We conducted a descriptive study of individual and small group QHPs to assess coverage, cost sharing (coinsurance vs. copay), specialty tiering, prior authorization, and out-of-pocket (OOP) costs for DTG/ABC/3TC and BIC/FTC/TAF. All individual and small group QHPs offered in state ACA Marketplaces from 2018-2020 were identified using plan-level formulary data from Ideon linked to end-of-year data from Robert Wood Johnson Foundation's Individual Market Health Insurance Exchange (HIX). RESULTS For 2018, 2019, and 2020, respectively, we identified 19,533, 17,007, and 21,547 QHPs. While DTG/ABC/3TC coverage was above 91% from 2018-2020, BIC/FTC/TAF coverage improved from 60 to 86%. Coverage of BIC/FTC/TAF improved in EHE priority jurisdictions from 73 to 90% driven by increased coverage with coinsurance. Although BIC/FTC/TAF had a higher wholesale acquisition cost than DTG/ABC/3TC, monthly OOP cost trends differed regionally in the Midwest but did not differ by EHE priority jurisdiction status. CONCLUSIONS QHP coverage of STRs is heterogeneous across the US. While coverage of BIC/FTC/TAF increased over time, many QHPs in EHE priority jurisdictions required coinsurance. Access to new ART regimens may be slowed by delayed QHP coverage and benefit design.
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Affiliation(s)
- Rohan Khazanchi
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Harvard Internal Medicine-Pediatrics Residency Program, Brigham & Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, MA, USA
- Departments of Internal Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
- FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Samuel Powers
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, P.O. Box 801379, Charlottesville, VA, 22908, USA
| | - Amy Killelea
- Health Systems and Policy, National Alliance of State and Territorial AIDS Directors (NASTAD), Washington, DC, USA
- Killelea Consulting, Arlington, VA, USA
| | - Andrew Strumpf
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, P.O. Box 801379, Charlottesville, VA, 22908, USA
| | - Tim Horn
- Health Systems and Policy, National Alliance of State and Territorial AIDS Directors (NASTAD), Washington, DC, USA
| | - Auntré Hamp
- Health Systems and Policy, National Alliance of State and Territorial AIDS Directors (NASTAD), Washington, DC, USA
| | - Kathleen A McManus
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, P.O. Box 801379, Charlottesville, VA, 22908, USA.
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Sorum P, Stein C, Wales D, Pratt D. A Proposal to Increase Value and Equity in the Development and Distribution of New Pharmaceuticals. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:363-371. [PMID: 35546103 PMCID: PMC9203670 DOI: 10.1177/00207314221100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The process of developing and marketing new pharmaceuticals in the United States is driven by a need to maximize returns to shareholders. This results all too often in the production of new medications that are expensive and of marginal value to patients and society. In line with our heightened awareness of the importance of social justice and public health—and in light of our government‘s alliance with private companies in bringing us COVID-19 vaccines—we need to reconsider how new pharmaceuticals are developed and distributed. Accordingly, we propose the creation of a new agency of the Food and Drug Administration (FDA) that would direct the whole process. This agency would fund the research and development of high-value medications, closely monitor the clinical studies of these new drugs, and manage their distribution at prices that are value-based, fair, and equitable.
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Affiliation(s)
- Paul Sorum
- Internal Medicine and Pediatrics, 1092Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | | | - Danielle Wales
- Internal Medicine and Pediatrics, 1092Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | - David Pratt
- 167519Schenectady County Public Health Services, Schenectady, NY, USA
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Amo-Adjei J, Nurzhynska A, Essuman R, Lohiniva AL. Trust and willingness towards COVID-19 vaccine uptake: a mixed-method study in Ghana, 2021. Arch Public Health 2022; 80:64. [PMID: 35189963 PMCID: PMC8860287 DOI: 10.1186/s13690-022-00827-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/10/2022] [Indexed: 12/29/2022] Open
Abstract
Background On the account of limited doses of COVID-19 available to the country, the Government of Ghana created a priority list of persons to target for its vaccination agenda. In this paper, we look at trust and how it informs willingness to take the COVID-19 vaccine among persons targeted for the first phase of COVID-19 vaccination program in Ghana. Methods A sequential mixed-method investigation was conducted among the priority population - persons 60 years and above, frontline government functionaries, health workers, persons with underlying health conditions and, religious leaders and teachers. We sampled 415 respondents from the target population for a survey and 15 religious and traditional leaders from three cities; Accra, Cape Coast and Tamale for follow-up in-depth interviews based on the results of the survey data. Quantitative data is presented with descriptive proportions and multinomial logistic regression and thematic approach is applied to the interview data. Results Trust and willingness to take the vaccine are high in this priority population. Trust in the effectiveness and safety of the vaccine, rather than socioeconomic characteristics of respondents better predicted acceptance. From interview narratives, mistrust in political actors - both local and foreign, believe in superior protection of God and seeming misunderstanding of vaccine development processes countermand acceptance. On the other hand, the professional influence of people in one’s social networks, and past triumphs of vaccination programmes against concerning childhood diseases embed trust and acceptance. Conclusions Attention ought to be given to trust enhancing triggers while strategic communication approaches are used to remove triggers of mistrust.
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Affiliation(s)
- Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
| | | | - Ruth Essuman
- Kantar Public, Ghana Country Office, Accra, Ghana
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Lauenroth VD, Kesselheim AS, Sarpatwari A, Stern AD. Lessons From The Impact Of Price Regulation On The Pricing Of Anticancer Drugs In Germany. Health Aff (Millwood) 2020; 39:1185-1193. [DOI: 10.1377/hlthaff.2019.01122] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Victoria D. Lauenroth
- Victoria D. Lauenroth was a research associate at the Hamburg Center for Health Economics, in Hamburg, Germany, and a visiting researcher at the Harvard-MIT Center for Regulatory Science, Harvard Medical School, in Boston, Massachusetts, when this work was conducted
| | - Aaron S. Kesselheim
- Aaron S. Kesselheim is a professor of medicine and the director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, in Boston
| | - Ameet Sarpatwari
- Ameet Sarpatwari is an assistant professor of medicine and the assistant director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Ariel D. Stern
- Ariel D. Stern is the Poronui Associate Professor of Business Administration in the Technology and Operations Unit at Harvard Business School and the Harvard-MIT Center for Regulatory Science, both in Boston
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Pérez AV, Trujillo AJ, Mejia AE, Contreras JD, Sharfstein JM. Evaluating the centralized purchasing policy for the treatment of hepatitis C: The Colombian CASE. Pharmacol Res Perspect 2019; 7:e00552. [PMID: 31857910 PMCID: PMC6902741 DOI: 10.1002/prp2.552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 11/23/2022] Open
Abstract
The high cost of drugs for hepatitis C limits access and adherence to treatment. In 2017, the Colombian health care system decided to design a strategy. It consisted of centralized purchasing, regulations, clinical practice guidelines, and direct observation of the treatment and follow-up of patients. The main objective of this study was to assess the centralized purchasing strategy in Colombia. The study design was a policy implementation assessment. We analyzed the change in prices, the clinical outcomes, and the opinions of stakeholders using data from the Ministry of Health. Additional information about effectiveness came from the Colombian Fund for High-Cost Diseases and semi-structured interviews of the stakeholders. The follow-up was from October, 2017 to October, 2018. The total number of patients reported in the cohort period was 1069. The number that finished 12 weeks of treatment, completed the follow-up for the case closure, and were considered cured through the end of October, 2018 was 563 (53%). The remainder, 506 patients (47%), are currently in treatment. A total of 543 of these treated patients (96%) were cured. After implementing this strategy, the drug prices decreased by more than 90% overall. Before implementation, the total direct cost was $100 102 171.75 dollars. Afterward, the cost was $8 378 747 dollars.
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Affiliation(s)
- Angela V. Pérez
- Johns Hopkins Bloomberg School of Public Health101 North Wolfe StreetApt 415BaltimoreMDUSA
| | - Antonio J. Trujillo
- International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Aurelio E. Mejia
- Health TechnologiesMinistry of Health and Social ProtectionBogotáColombia
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Borges Dos Santos MA, Dos Santos Dias LL, Santos Pinto CDB, da Silva RM, Osorio-de-Castro CGS. Factors influencing pharmaceutical pricing - a scoping review of academic literature in health science. J Pharm Policy Pract 2019; 12:24. [PMID: 31391943 PMCID: PMC6595602 DOI: 10.1186/s40545-019-0183-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Pharmaceutical pricing has only recently gained space in mainstream health science literature. Objectives Bibliometric and content description of health science academic literature and ad hoc analysis of grey literature on factors influencing pharmaceutical pricing on databases commonly accessed by healthcare professionals. Methods Scoping study with no time limits performed in Medline, Scopus and Scielo, and relevant sites and databases for grey literature, using search terms with database-appropriate keywords. Results Two hundred four articles were published in 103 peer-reviewed journals between 1981 and 2016 (last search year). In grey literature 78 documents were retrieved in the final selection. Five key thematic clusters for analysing pharmaceutical pricing emerged: market dynamics, segmented into (i) supply-related, (ii) consumer-related and (iii) product-related; (iv) trading strategies, either buyer’s or seller’s and (v) regulatory approach. In peer-reviewed literature there is an overall dominance of themes referring to trading strategies and regulatory approaches and a wide thematic cluster scope. Over half of this literature was produced after the year 2010. International agency technical papers make up the most significant contributions of grey literature, with a clear focus on regulatory approaches to pricing and wider consideration of emerging countries. Research lags in the literature on factors affecting pharmaceutical pricing include impacts of financing schemes, market liberalization, internet trading and biosimilars on prices, with insufficient discussion identified for the effects of discounts/rebates, profits and price transparency. Conclusions Interest in pharmaceutical pricing literature is increasing. Robust evidence-producing study designs for pricing interventions will be a welcome development. Electronic supplementary material The online version of this article (10.1186/s40545-019-0183-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Angelica Borges Dos Santos
- 1Vice Direção de Escola de Governo, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Av. Brasil, 4036 sala 902, Manguinhos, Rio de Janeiro, Brazil
| | | | | | - Rondineli Mendes da Silva
- 4Departamento de Política de Medicamentos e Assistência Farmacêutica da Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Claudia Garcia Serpa Osorio-de-Castro
- 4Departamento de Política de Medicamentos e Assistência Farmacêutica da Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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