Cost, coverage concerns cited as barriers to acne medication adherence

 

Patients with acne who did not follow through with treatment cited high prices and insurance barriers as their main reasons for medication nonadherence, in a study published in JAMA Dermatology.

In the study, more than half of the 26 participants interviewed reported that they intended to fill the acne prescriptions but were not able to do so because of cost- or insurance-related concerns, reported Kira L. Ryskina, MD, of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, and her coauthors.

Kenishirotie/Thinkstock

In their study, they first identified 385 potential participants using electronic medical records from four dermatology practices affiliated with the University of Pennsylvania Health System. Participants had been prescribed acne medications by a dermatologist between August 1 and November 3, 2016, but did not initiate treatment. Nonadherence was self-reported and included not submitting prescriptions to the pharmacy, not picking up medications, and picking up but not using medications, the authors said.

Of the initial 385 patients, 26 agreed to participate and met inclusion criteria. Most (58%) were aged 26-40 years, 19% were over aged 40, and 23% were younger than aged 26; 73% were female. Almost 40% had Medicaid coverage, 54% had commercial insurance, and the rest had “other.” Structured interviews were conducted via telephone between November 30, 2016, and January 31, 2017. Based on recorded interviews, five major themes were identified by investigator consensus: medication costs, poor understanding of prior authorization, physician-patient communication about costs, solutions and back-up plans offered by physicians, and reservations about treatment.

 

Of the 26 participants, 17 (65%) said they were unable to fill acne medication prescriptions because of price or barriers related to coverage. Lack of insurance coverage was a concern for 10 patients (38%), and high out-of-pocket costs were a concern for 11 patients (42%), the authors reported. Additionally, 5 participants (19%) said they had received inconsistent information from physicians, physician’s office staff, and pharmacy staff about the prior authorization process.

Participants reported having discussions with providers about treatment side effects and instructions for use – but not about price concerns. In addition, patients “did not expect physicians to know medication cost or insurance coverage,” the authors said. The patients also described various approaches recommended by providers to address problems obtaining medication, including asking patients to call the office back (7%), shopping around for medication (7%), suggesting alternatives to first-line treatment (7%), and offering coupons (4%). Backup plans (offered when the medication was not available) were received positively by 23% of the patients, as was a candid conversation about cost (19%), whereas shopping around and calling the office back were not, the authors said.

Overall, 10 patients (38%) reported reservations about treatment, which included concerns about possible adverse effects (15%), unwillingness to start a “strong” medication (8%), desire to try homeopathic treatment (3%), and belief that their acne was not serious enough to require medication (12%).

The results suggest that “physician-level interventions to improve primary adherence should incorporate discussion of medication costs and provide specific alternative plans in case the patient is unable to fill the prescription, rather than asking patients to call back,” the authors wrote. “Physicians who discuss medication costs and provide a concrete alternative plan may be able to improve primary adherence among their patients,” they concluded.

 

Limitations of the study include its qualitative nature and its limited generalizability because all participants were part of the same Philadelphia health system.

The study was funded by a Pfizer grant from the American Academy of Dermatology and was cosponsored by the Pennsylvania Academy of Dermatology and Dermatologic Surgery.

dermnews@mdedge.com

SOURCE: Ryskina K et al. JAMA Dermatol. 2018 Feb 28. doi: 10.1001/jamadermatol.2017.6144.

 

Patients with acne who did not follow through with treatment cited high prices and insurance barriers as their main reasons for medication nonadherence, in a study published in JAMA Dermatology.

In the study, more than half of the 26 participants interviewed reported that they intended to fill the acne prescriptions but were not able to do so because of cost- or insurance-related concerns, reported Kira L. Ryskina, MD, of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, and her coauthors.

Kenishirotie/Thinkstock

In their study, they first identified 385 potential participants using electronic medical records from four dermatology practices affiliated with the University of Pennsylvania Health System. Participants had been prescribed acne medications by a dermatologist between August 1 and November 3, 2016, but did not initiate treatment. Nonadherence was self-reported and included not submitting prescriptions to the pharmacy, not picking up medications, and picking up but not using medications, the authors said.

Of the initial 385 patients, 26 agreed to participate and met inclusion criteria. Most (58%) were aged 26-40 years, 19% were over aged 40, and 23% were younger than aged 26; 73% were female. Almost 40% had Medicaid coverage, 54% had commercial insurance, and the rest had “other.” Structured interviews were conducted via telephone between November 30, 2016, and January 31, 2017. Based on recorded interviews, five major themes were identified by investigator consensus: medication costs, poor understanding of prior authorization, physician-patient communication about costs, solutions and back-up plans offered by physicians, and reservations about treatment.

 

Of the 26 participants, 17 (65%) said they were unable to fill acne medication prescriptions because of price or barriers related to coverage. Lack of insurance coverage was a concern for 10 patients (38%), and high out-of-pocket costs were a concern for 11 patients (42%), the authors reported. Additionally, 5 participants (19%) said they had received inconsistent information from physicians, physician’s office staff, and pharmacy staff about the prior authorization process.

Participants reported having discussions with providers about treatment side effects and instructions for use – but not about price concerns. In addition, patients “did not expect physicians to know medication cost or insurance coverage,” the authors said. The patients also described various approaches recommended by providers to address problems obtaining medication, including asking patients to call the office back (7%), shopping around for medication (7%), suggesting alternatives to first-line treatment (7%), and offering coupons (4%). Backup plans (offered when the medication was not available) were received positively by 23% of the patients, as was a candid conversation about cost (19%), whereas shopping around and calling the office back were not, the authors said.

Overall, 10 patients (38%) reported reservations about treatment, which included concerns about possible adverse effects (15%), unwillingness to start a “strong” medication (8%), desire to try homeopathic treatment (3%), and belief that their acne was not serious enough to require medication (12%).

The results suggest that “physician-level interventions to improve primary adherence should incorporate discussion of medication costs and provide specific alternative plans in case the patient is unable to fill the prescription, rather than asking patients to call back,” the authors wrote. “Physicians who discuss medication costs and provide a concrete alternative plan may be able to improve primary adherence among their patients,” they concluded.

 

Limitations of the study include its qualitative nature and its limited generalizability because all participants were part of the same Philadelphia health system.

The study was funded by a Pfizer grant from the American Academy of Dermatology and was cosponsored by the Pennsylvania Academy of Dermatology and Dermatologic Surgery.

dermnews@mdedge.com

SOURCE: Ryskina K et al. JAMA Dermatol. 2018 Feb 28. doi: 10.1001/jamadermatol.2017.6144.

 

Patients with acne who did not follow through with treatment cited high prices and insurance barriers as their main reasons for medication nonadherence, in a study published in JAMA Dermatology.

In the study, more than half of the 26 participants interviewed reported that they intended to fill the acne prescriptions but were not able to do so because of cost- or insurance-related concerns, reported Kira L. Ryskina, MD, of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, and her coauthors.

Kenishirotie/Thinkstock

In their study, they first identified 385 potential participants using electronic medical records from four dermatology practices affiliated with the University of Pennsylvania Health System. Participants had been prescribed acne medications by a dermatologist between August 1 and November 3, 2016, but did not initiate treatment. Nonadherence was self-reported and included not submitting prescriptions to the pharmacy, not picking up medications, and picking up but not using medications, the authors said.

Of the initial 385 patients, 26 agreed to participate and met inclusion criteria. Most (58%) were aged 26-40 years, 19% were over aged 40, and 23% were younger than aged 26; 73% were female. Almost 40% had Medicaid coverage, 54% had commercial insurance, and the rest had “other.” Structured interviews were conducted via telephone between November 30, 2016, and January 31, 2017. Based on recorded interviews, five major themes were identified by investigator consensus: medication costs, poor understanding of prior authorization, physician-patient communication about costs, solutions and back-up plans offered by physicians, and reservations about treatment.

 

Of the 26 participants, 17 (65%) said they were unable to fill acne medication prescriptions because of price or barriers related to coverage. Lack of insurance coverage was a concern for 10 patients (38%), and high out-of-pocket costs were a concern for 11 patients (42%), the authors reported. Additionally, 5 participants (19%) said they had received inconsistent information from physicians, physician’s office staff, and pharmacy staff about the prior authorization process.

Participants reported having discussions with providers about treatment side effects and instructions for use – but not about price concerns. In addition, patients “did not expect physicians to know medication cost or insurance coverage,” the authors said. The patients also described various approaches recommended by providers to address problems obtaining medication, including asking patients to call the office back (7%), shopping around for medication (7%), suggesting alternatives to first-line treatment (7%), and offering coupons (4%). Backup plans (offered when the medication was not available) were received positively by 23% of the patients, as was a candid conversation about cost (19%), whereas shopping around and calling the office back were not, the authors said.

Overall, 10 patients (38%) reported reservations about treatment, which included concerns about possible adverse effects (15%), unwillingness to start a “strong” medication (8%), desire to try homeopathic treatment (3%), and belief that their acne was not serious enough to require medication (12%).

The results suggest that “physician-level interventions to improve primary adherence should incorporate discussion of medication costs and provide specific alternative plans in case the patient is unable to fill the prescription, rather than asking patients to call back,” the authors wrote. “Physicians who discuss medication costs and provide a concrete alternative plan may be able to improve primary adherence among their patients,” they concluded.

 

Limitations of the study include its qualitative nature and its limited generalizability because all participants were part of the same Philadelphia health system.

The study was funded by a Pfizer grant from the American Academy of Dermatology and was cosponsored by the Pennsylvania Academy of Dermatology and Dermatologic Surgery.

dermnews@mdedge.com

SOURCE: Ryskina K et al. JAMA Dermatol. 2018 Feb 28. doi: 10.1001/jamadermatol.2017.6144.