Search PubMed⌕ Search

Biomedical subjects

Kavita V Nair

Publications and source records attributed to Kavita V Nair.

9 recordsLinked to original sources
PubMed2005

Quality assessment of dyslipidemia in managed care: current best evidence should be used to benchmark quality.

Quality measurements in managed care allow purchasers of health care to distinguish between health plans. Existing measures (Health Plan Employer Data and Information Set goals) for treatment of dyslipidemia provide a limited snapshot about quality of care for members within commercial health plans. Newer evidence (ie, the Heart Protection Study) and consensus guidelines (the National Cholesterol Education Program) expand the definition of high-risk populations and emphasize pharmacotherapy in managing dyslipidemia. We believe that newer evidence and standards provide health plans with the best opportunity to accurately assess the quality of dyslipidemia care for their populations. We propose a broad framework that provides health plans with guidance on developing a new quality measure for dyslipidemia that focuses on pharmacotherapy.

Adult↗
PubMed2005

The effect of the Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy.

BACKGROUND: Numerous prescription products have become available over the counter (OTC) in recent years. Previous simulation models have shown the Rx-to-OTC switch of loratadine to be cost effective. OBJECTIVE: To empirically assess the overall effect of the Rx-to-OTC switch of loratadine and the specific effect of different pharmacy benefit structures on prescription drug utilization and cost among different plan sponsors. METHODS: Data from a national pharmacy benefit management organization covering lives throughout the United States were used. The analysis included a comparison of the before and after change in prescription utilization and cost for plan sponsors that instituted 1 of 3 second-generation antihistamine (SGA) benefit responses: made no change, moved SGAs to the third tier, or restricted SGA benefits through a requirement for prior authorization. Multivariate regression analysis was used to control for differences across the study groups. RESULTS: There was a substantial decrease in utilization and cost of all prescription drugs and combinations of drug classes. Patients with allergic rhinitis facing restricted prescription benefits for SGAs did not appear to increase utilization of other allergic rhinitis medications or other medications used to treat comorbid conditions such as asthma, sinusitis, and otitis media. CONCLUSIONS: Utilization and cost decreased substantially for all types of medications and all pharmacy benefit structures. Future studies need to examine the effect of the Rx-to-OTC switch of loratadine and resultant prescription benefit policies on medical utilization and OTC antihistamine utilization.

Adult↗
PubMed2004

Consumer attitudes and factors related to prescription switching decisions in multitier copayment drug benefit plans.

OBJECTIVES: To examine patient attitudes related to formulary medications and medication-related decision making in multitier copayment prescription drug plans. STUDY DESIGN: A cross-sectional retrospective analysis. METHODS: Data were collected via mail survey from a random sample of 25,008 members of a managed care organization. The selected members were enrolled in a variety of 2- and 3-tier copayment plans and were taking prescription medication to treat 1 or more of 5 chronic disease states. RESULTS: Most respondents did not believe that formulary drugs were safer or more effective than nonformulary drugs, but 39.7% thought that formulary drugs were relatively less expensive. Most respondents appeared willing to consider switching from a nonformulary drug to a formulary drug with a lower copayment. The percent of respondents who reported they would be very unlikely or unlikely to switch was only 15.3% for a new prescription and 24.2% for a refill prescription. Medication efficacy and physician opinion were important factors in plan members' switching decisions. Cost was an important factor for some members, but older plan members were less likely to report that cost was important. CONCLUSIONS: Multitier plan members generally believed that drugs are placed on the formulary for reasons of cost rather than safety or efficacy. Most plan members were receptive to switching from a nonformulary to a formulary medication, but financial incentives alone may not convince some plan members to make the switch.

Adult↗
PubMed2004

Consumer responses to a pharmacy benefit report card.

As pharmacy benefits become an increasingly important component of rising health care costs, report cards critically need to be developed to inform consumers about the availability of their medications, what these medications cost them, and additional pharmacy benefit services that can enhance the management of their disease. This study is a preliminary step for developing such a card and assessing its impact on health plan enrollment choices in a small employee sample. Findings indicate that while individuals generally had positive comments about the pharmacy benefit report card, the card had little effect on their health plan enrollment decisions. The higher the prescription use reported by individuals, more likely they were to report that the card influenced their health plan enrollment decisions. The pharmacy benefit report card could be an useful tool for specific populations such as those with an increased need for medication.

Consumer Behavior↗
PubMed2003

A retrospective cohort study of correlates of response to pharmacologic therapy for hyperlipidemia in members of a managed care organization.

BACKGROUND: Few studies have examined the effectiveness of statins in a managed care setting. OBJECTIVE: The aim of this study was to identify demographic, clinical, and pharmacotherapy-related factors associated with response to drug therapy for hyperlipidemia among members of a managed care organization. METHODS: Claims data from a large US managed care organization from July 1, 1998, through June 30, 2000, were analyzed for adult members with continuous enrollment, >or=1 prescription drug claim, >or=2 sets of fasting low-density lipoprotein cholesterol (LDL-C) laboratory results, and no lipid-lowering prescription claims at any time or=41%). Multiple regression and logistic regression models were developed to identify significant predictors of percentage change in LDL-C from baseline and of >or=10% reduction in LDL-C. RESULTS: A total of 6247 members met the inclusion criteria. The mean (SD) age was 59.6 (12.4) years (range, 21-93 years), and 3003 individuals (48.1%) were women. Furthermore, 337 members (5.4%) received high-efficacy statins, 2633 (42.1%) received moderate-efficacy statins, 934 (15.0%) received low-efficacy statins, and 86 (1.4%) received low-efficacy lipid-lowering drugs from other therapeutic classes during the study period. Compliance with therapy was high (range, 85%-92%), and upward titration of therapy was found in only 160 members (2.6%). Multiple regression analysis indicated that receiving statin therapy compared with other lipid-lowering therapy was a significant predictor of percentage reduction in LDL-C (P < 0.001). Logistic regression analysis indicated that compared with high-efficacy statin regimens, low-efficacy statin regimens (odds ratio [OR] = 0.619; 95% CI, 0.436-0.877) and low-efficacy regimens from other therapeutic classes (OR = 0.171; 95% CI, 0.099-0.295) were less effective in lowering LDL-C by >or=10%. Similar results were observed for subanalyses of subjects with diabetes mellitus or coronary heart disease (CHD); individuals who received more efficacious statin regimens were more likely to reach the National Cholesterol Education Program Adult Treatment Panel II LDL-C goal of <or=100 mg/dL (P < 0.05 for moderate- or low-efficacy regimens vs high-efficacy statins in each model). CONCLUSION: The results of the present study suggest that improvement is needed in hyperlipidemia management, especially in identification and use of lipid-lowering therapy in individuals at high risk for CHD.

Adult↗
PubMed2003

Do consumers' attitudes predict prescription purchasing behavior?

Consumers may face prescription choices in three-tier plans, primarily between lower-cost generic drugs, formulary (tier 2) brands, and higher-cost nonformulary (tier 3) brands. To determine if consumers' beliefs about medications influence their prescription choices, a preliminary evaluation of the effect of such beliefs on prescription purchasing behavior was conducted in an MCO population. Attitudes about prescription drug coverage and perceptions regarding medications had no demonstrated effect on formulary compliance or rates of discontinuation of nonformulary medications. The findings appear to support the concept of three-tier plans, and increasing copayments seems to facilitate greater adherence to health plan formularies.

Adolescent↗
PubMedDate not supplied

Impact of multi-tiered pharmacy benefits on attitudes of plan members with chronic disease states.

OBJECTIVE: To evaluate the effects of 2- and 3-tiered pharmacy benefit plans on member attitudes regarding their pharmacy benefits. METHODS: We performed a mail survey and cross-sectional comparison of the outcome variables in a large managed care population in the western United States. Participants were persons with chronic disease states who were in 2- or 3-tier copay drug plans. A random sample of 10,662 was selected from a total of 25,008 members who had received 2 or more prescriptions for a drug commonly used to treat one of 5 conditions: hypertension, diabetes, dyslipidemia, gastroesophageal reflux disease (GERD), or arthritis. Statistical analysis included bivariate comparisons and regression analysis of the factors affecting member attitudes, including satisfaction, loyalty, health plan choices, and willingness to pay a higher out-of-pocket cost for medications. RESULTS: A response rate of 35.8% was obtained from continuously enrolled plan members. Respondents were older, sicker, and consumed more prescriptions than nonrespondents. There were significant differences in age and health plan characteristics between 2- and 3-tier plan members: respondents aged 65 or older represented 11.7% of 2-tier plan members and 54.7% of 3-tier plan members, and 10.0% of 2-tier plan members were in Medicare+Choice plans versus 61.4% in Medicare+Choice plans for 3-tier plan members (P<0.05). Controlling for demographic characteristics, number of comorbidities, and the cost of health care, 2-tier plan members were more satisfied with their plan, more likely to recommend their plan to others, and less likely to switch their current plans to obtain better prescription drug coverage than 3-tier plan members. While members were willing to purchase higher cost nonformulary and brand-name medications, in general, they were not willing to pay more than 10 dollars (in addition to their copayment amount) for these medications. Older respondents and sicker individuals (those with higher scores on the Chronic Disease Indicator) appeared to have more positive attitudes toward their pharmacy benefit plans in general. Higher reported incomes by respondents were also associated with greater satisfaction with prescription drug coverage and increased loyalty toward the pharmacy benefit plan. Conversely, the more individuals spent for either their health care or prescription medications, the less satisfied they were with their prescription drug coverage and less loyalty they appeared to have for their health plans. An inverse relationship also appeared to exist between the out-of-pocket costs for prescription medications and members' willingness to pay for nonformulary medications. CONCLUSIONS: Three-tier members had lower reported satisfaction with their plans compared to members in 2-tier plans. The financial resources available to members (which may be a function of being older and having more education and higher incomes), the number of chronic disease states that members have, and other factors may influence their attitudes toward their prescription drug coverage.

Journal Article↗
PubMedDate not supplied

Effects of a 3-tier pharmacy benefit design on the prescription purchasing behavior of individuals with chronic disease.

OBJECTIVE: To evaluate the impact of 3-tier (copayment) pharmacy benefit structures on medication utilization behavior. METHODS: A pretest-posttest quasi-experimental design was employed. Chronic disease sufferers (N=8,132) from a health plan were classified into the following groups: (a) 2-tier copayment moving to a 3-tier structure, (.converting. group), (b) 2-tier staying in a 2-tier structure and, (c) 3-tier staying in a 3-tier structure. The latter 2 were.comparison. groups. Two 7-month time periods were determined: the.preperiod. (June through December 2000) and the.postperiod. (January through July 2001) for a change in pharmacy benefit structure. Pharmacy claims data were used for data collection. Statistical analyses included bivariate tests to evaluate predifferences and postdifferences across study groups. Maximum likelihood estimates from a repeated measures model were used to examine changes in formulary compliance and generic use rates. Discontinuation of nonformulary medications was evaluated using logistic regression. RESULTS: Controlling for demographics, number of comorbidities, disease state, and pharmacy benefit structure, the formulary compliance rate increased by 5.6% for the converting group. No significant increases were seen for the comparison groups. Generic use rates increased by 6 to 8 absolute percentage points for all groups (3.3% to 4.9 % adjusted rates). Converting group members were 1.76 times more likely to discontinue their nonformulary medication than those in the 2-tier comparison group and 1.49 times more likely than those in the 3-tier comparison group. CONCLUSIONS: These findings suggest that shifting individuals from a 2-tier to a 3-tier drug benefit copayment structure resulted in changes in medication utilization. Decision makers need to balance these changes with the potential dissatisfaction that members may express in paying higher copayments.

Aged↗