Demand for a Medicare Prescription Drug Benefit: Exploring Consumer Preferences under a Managed Competition Framework

Patients' Satisfaction With Medication Delivery Pharmacy Services in a Tertiary Hospital in Asir, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Pharmaceutical care plays a crucial role in optimizing medication administration and improving patient health outcomes. However, medication adherence remains a challenge, with a significant percentage of patients discontinuing their medications. Value-added services (VASs), such as medication delivery, have been introduced to enhance pharmacy services and medication adherence.

OBJECTIVE

This study aims to evaluate satisfaction with a new medication delivery service at an Armed Forces Hospital outpatient pharmacy in Saudi Arabia and identify factors impacting utilization.

METHODS

A cross-sectional survey assessed patient satisfaction with a new pharmacy delivery service between January 2023 and March 2023. The target population consisted of adult patients who had used the pharmacy delivery service for at least one month. The survey contained 23 Likert scale questions assessing satisfaction across three domains: delivery process/personnel, medication quality, and pharmacist adherence to best practices.

RESULTS

A total of 110 patients responded to the survey, 383 invited patients; the mean age was 51.2 ± 15.3, and most were male 92 (83.6%), married 97 (88.2%), and living in urban areas 63 (57.3%). The overall satisfaction rate was 97 (88.1%), with 67 (60.9%) reporting satisfaction with the medication delivery service. On the delivery process/personnel items, over half strongly agreed that the delivery person called before arriving 59 (53.6%), medications were received on time 58 (51.8%), and the delivery person was polite 64 (58.2%). Most strongly agreed that the service helped with adherence 70 (63.6%) and saved travel costs 72 (65.5%) for medication-quality items. Most also strongly agreed that medications were properly packaged 65 (59.1%) and labeled 71 (64.5%). Regarding pharmacist practices, approximately 56 (50.9%) strongly agreed that the pharmacist provided education materials, inquired about adherence 49 (44.5%), and was respectful 55 (50%). Bivariate analyses found no significant associations between satisfaction and age, gender, residence, education, marital status, income, or disease (all p > 0.05). Satisfaction remained uniformly high across subgroups.

CONCLUSION

The medication delivery service demonstrated excellent patient reception regardless of its characteristics. Overall satisfaction with these services was high. There was no association between sociodemographic characteristics and the level of satisfaction. Continued monitoring and refinement could maximize the quality of pharmaceutical care afforded through innovative models supporting medication adherence.

Drug Benefit Decisions among Older Adults: A Policy-Capturing Analysis

Purpose . Under the Medicare Prescription Drug Improvement and Modernization Act, beneficiaries remaining in the traditional fee-for-service plan will face a variety of drug benefit options provided by private stand-alone prescription drug plans. Although these plans likely will differ with regard to a number of important attributes, little is known about older adults’ judgment processes in this context. The objectives of this study were to 1) better understand the manner in which drug insurance attributes are weighted in older adults’ judgments of drug benefit suitability, 2) explore variability in judgment strategies among seniors, and 3) assess seniors’ insight into their judgment policies. Methods . Three focus groups were conducted with 19 older adults to elicit important drug plan attributes. A policy-capturing study with 32 seniors, none of whom had participated in the focus groups, then was employed to quantify the impacts of these attributes on judgments of plan suitability. Results . Focus group participants reported that copayment, monthly premium, deductible, formulary use, and mail-order pharmacy use were important drug insurance attributes. The policy-capturing study showed that deductibles and premiums were weighted most heavily in judgment formation. However, significant variability in judgment policies was apparent, with 3 distinct groups emerging from cluster analysis. The first emphasized deductibles and copayments, the second premiums and deductibles, and the third use of a mail-order pharmacy and deductibles. Study volunteers exhibited insight into the role of some plan attributes in their judgments, but notm others. Conclusions. Cost-sharing provisions appear to be most important in older adults’ evaluations of drug benefit plans. However, significant heterogeneity in attribute preferences also was apparent in this study. Older adults may not be cognizant of the manner in which some plan attributes affect their evaluations, suggesting a role for decision aids in this process.

Revealed preference for community and mail service pharmacy

OBJECTIVE

To determine revealed pharmacy preference and predictors among patients enrolled in a pharmacy benefit that offered a 90-day supply of prescriptions via mail service and community pharmacy channels, with no differences in out-of-pocket costs.

DESIGN

Retrospective cohort study.

SETTING

United States in 2008-09.

PATIENTS

324,968 commercially insured participants enrolled in plans that required use of mail service pharmacy for maintenance medications.

INTERVENTION

Implementation of a pharmacy benefit design with optional use of either mail service or community pharmacy for 90-day supply prescriptions.

MAIN OUTCOME MEASURES

Selection rates of mail service and community pharmacy and adjusted odds ratios for predicting community pharmacy for selected characteristics.

RESULTS

In the first 4 months of the benefit design, 31.8% of participants previously mandated to use mail service pharmacy elected to fill 90-day prescriptions at community pharmacies. Selection of community pharmacy ranged from a low of 23.7% (previous mail service pharmacy users) to 66.3% (previous community pharmacy users). Among those initiating therapy, 44.3% selected community pharmacy for their new prescriptions, and among those with no previous mail use, 68% selected community pharmacy for new prescriptions. Preference for community/mail service pharmacy was dependent on numerous characteristics, including age, gender, household income, region, driving distance (time), and concomitant medication use.

CONCLUSION

Patient behavior indicates that certain patients prefer to access prescription medications via mail service and others through community pharmacy channels. Restrictive benefit designs that incentivize patients to use less preferable pharmacy channels may adversely affect patient convenience, which could have the unintended consequence of reducing medication use and adherence.

Judgment processes in older adults' drug benefit evaluations

BACKGROUND

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 will provide drug coverage to older adults through a variety of mechanisms, including stand-alone prescription drug benefits. Variation in cost-sharing and utilization controls is permitted, leading potentially to a wide variety of prescription benefit plans. However, little is known regarding the manner in which beneficiaries will integrate information to form plan evaluations.

OBJECTIVES

The objectives of this study were to assess and compare the use of compensatory and configural judgment models in older adults' evaluations of drug benefit plans.

METHODS

Three focus groups were conducted with a total of 19 seniors to elicit relevant drug plan attributes. A separate group of 32 seniors then judged the suitability of 48 drug benefit profiles based on these attributes. Within-subjects regression analysis was used to reveal each participant's judgment policy.

RESULTS

Focus groups suggested that copayment, premium, deductible, formulary use, and mail-service use were relevant plan attributes. Regression analyses showed that while most participants used compensatory judgment models in evaluation formation, 12 (37.5%) subjects used conjunctive judgment models.

CONCLUSIONS

Configural judgment processes are used frequently by older adults when evaluating drug benefit plans. Future research using more fine-grained techniques (eg, process tracing) might help further elucidate judgment processes in this context.

Exploring the demand for a voluntary Medicare prescription drug benefit

The purposes of this study were (1) to assess the utility of the economic theory of demand for insurance for modeling voluntary Medicare drug benefit enrollment decisions and (2) to explore the degree of adverse selection and crowd-out that might occur under a voluntary enrollment Medicare prescription benefit. Data were collected using a cross-sectional, mail survey of 2,100 community-dwelling adults aged 65 and older in Wisconsin. Respondents were asked to evaluate their likelihood of enrollment in any of 4 hypothetical drug benefit plans under the assumption that they could enroll in one of the hypothetical plans or maintain their current coverage. Data analyses included bivariate comparisons across enrollment likelihood categories and logit analysis of enrollment likelihood as a function of respondent characteristics. 1041 usable survey forms were returned for an adjusted response rate of 51.5%. Older adults with 4 or more chronic conditions were most likely to report that they were "very likely" to enroll in one of the hypothetical drug plans, as were those with the highest out-of-pocket drug spending in the previous 30 days. Respondents with no or self-purchased drug benefits were more likely than those with employer-based plans to express a higher likelihood of enrollment in one of the hypothetical plans. Adverse selection may be problematic for a voluntary enrollment Medicare drug benefit. Given that high out-of-pocket drug spending (secondary to drug coverage source) was a consistent predictor of enrollment likelihood, demand-side factors affecting the crowding out of employer-based drug coverage sources by a voluntary enrollment drug benefit appear minimal. However, the availability of a Medicare prescription benefit may still lead to crowd-out through employer incentives.