Cost-related underuse of heart meds may have adverse outcomes

Middle-aged and older Americans with heart disease who cut back on their prescribed medications because of cost were 50% more likely to suffer heart attacks, strokes, or angina than those who did not report cost-related medication underuse, according to a new study funded in part by the National Institute on Aging (NIA), which is part of the National Institutes of Health.

This is the first nationally representative longitudinal study to demonstrate that patients with serious chronic illnesses experience adverse health events when they restrict their use of prescription drugs due to cost.

The downturns in patients’ health were observed over a relatively brief (two- to three-year) period, suggesting that cost barriers to prescription drug use may have important short-term effects on older patients’ health and well-being, says Michele Heisler, MD, MPA, one of the researchers at the Veterans Affairs Ann Arbor (MI) Healthcare System, who conducted the study. The findings appeared in the July 2004 issue of Medical Care.

The study included 7,991 middle-aged and older Americans who participated in a survey conducted between 1995 and 1996 as part of the Health and Retirement Study, a NIA-supported survey of adults ages 51-61, or the Asset and Health Dynamics Among the Oldest Old Study, a national survey of adults age 70 or older.

All participants reported using prescription medication, and 546 reported that they had taken less medication than prescribed because of cost. Heisler and colleagues assessed a range of important health outcomes reported in participants’ subsequent surveys, conducted in 1998.

After controlling for risk factors for poor health outcomes, 32% of adults who had restricted medication use because of cost pressures reported a significant decline in their self-reported health status during their follow-up interviews compared to 21% of adults with no cost-related underuse. Self-reports of health have been found to strongly predict other serious life events, including mortality, according to the study.

In addition to cardiovascular declines, older individuals who restricted medication use because of cost had increased rates of depression, according to the study.

Researchers found no health differences among people with arthritis and diabetes who said they had restricted drug use due to cost. Community-dwelling people older than 65 paid an average of $410 for their drugs in 1999, and adults with multiple, chronic diseases paid twice as much, according to a cited study.

Many consumers do not favor off-label drug use

Many consumers say they don’t want physicians to prescribe drugs for off-label use, but a recent survey shows they are confused about the issue. For example, more than half of Americans (51%) in a recent poll wrongly believe that a physician can only prescribe drugs for their approved indications. In addition, only half of the respondents think that this practice actually happens very often (23%) or often (33%).

The findings were published from a Harris Interactive poll of 2,148 U.S. adults conducted on-line May 25-27, 2004, for The Wall Street Journal Online’s Health Industry Edition. Other findings from the poll include:

  • A 48% to 31% plurality contends that doctors should not be allowed to prescribe a drug for diseases for which that drug has not been approved by the FDA.
  • Pharmaceutical companies should not be allowed to encourage doctors to prescribe a drug for diseases for which that drug has not been FDA-approved (by 73% to 12%).

"There is a massive public ignorance of off-label prescribing," says Humphrey Taylor, chairman of The Harris Poll at Harris Interactive. "There are several strong arguments in favor of off-label prescribing, but these data suggest that it is a potentially risky issue for both physicians and the pharmaceutical industry."

Medicare extends access to self-administered drugs

The Department of Health and Human Services has announced a new Medicare demonstration program that will save seniors and people with disabilities substantial money on medicines they take for serious and chronic diseases.

The demonstration program, created as part of the Medicare Modernization Act, will extend Medicare coverage to prescription medicines that can be self-administered rather than administered by a health care provider. The demonstration will help up to 50,000 beneficiaries with serious illnesses who do not have comprehensive prescription drug coverage today.

The initiative, known as the Medicare Replacement Drug Demonstration, was mandated under Section 641 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. As set by Congress, enrollment in the demonstration will be open to 50,000 people and total spending on the covered drugs will be up to $500 million.

Program limits drugs covered

Under this initiative, Medicare will pay for certain drugs and biologicals that can be taken by the patient at home and that replace drugs that currently are covered under Medicare Part B when given in a physician’s office. In addition, newer, more effective medications that replace some currently covered oral anticancer drugs also will be covered.

Drugs for treatment of such diseases as rheumatoid arthritis, multiple sclerosis, pulmonary hypertension, and a variety of cancers will be included in the demonstration.

The drugs were selected based on criteria developed after extensive input from physicians and other experts. For a complete list of the drugs covered, see www.hhs.gov/news/press/2004pres/20040624.html.

Pfizer expands access to its prescription medications

Pfizer has announced that it will launch a comprehensive initiative to significantly expand access to its prescription medicines across the United States, with a specific focus on enabling America’s 43 million uninsured to obtain Pfizer medicines at significant savings.

Key elements of the new Pfizer initiative, "Helpful Answers," include:

  • Savings on Pfizer medicines for America’s uninsured, regardless of age or income, through "Pfizer Pfriends."

— Families making less than $45,000 per year (less than $31,000 for individuals) will receive average savings of 37%, and up to 50% off the average cash price at retail pharmacies for most Pfizer medicines.

— Families making more than $45,000 per year (more than $31,000 for individuals) will receive average savings of 15%, and up to 25% off the average cash price at retail pharmacies for most Pfizer medicines.

  • Expanded eligibility for existing Pfizer programs that provide free medicines.

— Connection to Care: Families making less than $31,000 per year (less than $19,000 for individuals) can receive free Pfizer medicines from their physicians’ offices.

— Sharing the Care and Hospital Partnership Program: Families making less than $31,000 (less than $19,000 for individuals) can receive free Pfizer medicines from eligible federally qualified community health centers and hospitals.

  • Extending Pfizer’s $15 flat fee for qualified Medicare beneficiaries.

— Low-income Medicare beneficiaries on all Medicare-approved drug discount cards will have access to many Pfizer medicines for a flat fee of $15 per prescription after they have exhausted the $600 credit. (Adjustments to income eligibility may be made at participating community health centers and hospitals based on family size.)

  • Creation of a consumer-friendly, single entry point navigation component for all uninsured patients.

— This month, Pfizer will launch a web site and a single toll-free number with live operators to help people without insurance, or their caregivers, find the program that best meets their needs.

— The web site and the toll-free number will inform patients of both public and Pfizer programs.

Enrollment for initiative begins this month.

Pharmacists are critical link to people with pain

Pain is the No. 1 cause of adult disability in the United States. Each year, 50 million people suffer from severe chronic pain, and another 25 million experience acute pain from injuries or surgeries. Yet despite important scientific advances in the management of pain, it continues to be vastly undertreated, resulting in needless patient suffering and complications.

Because of their knowledge about disease states and treatment options and their unique accessibility to patients, pharmacists play a critical role in providing pain management. They are in an ideal position to assist patients and ensure that their pain is treated properly.

Partners for Understanding Pain (PUP) is a consortium of more than 70 organizations, including patient advocacy groups, health care professional groups, and pain associations that have declared September as Pain Awareness Month. The mission of the coalition is to increase awareness and understanding of assessment, treatment, and management of pain among health care professionals and staff, patients, and the public.

This September, to support pharmacists’ efforts in pain management across the nation, PUP has created the Pharmacists’ Tool Kit. The kit offers:

  • education in the full array of pain management strategies;
  • outreach to the community and new ways to educate consumers about taking medications;
  • ideas for bridging the gap between patients and health care providers;
  • resources available from the PUP organizations.

The tool kits will be distributed in August. To request a free tool kit, visit the PUP web site at www.understandingpain.org or e-mail ACPA@pacbell.net or call (800) 533-3231.