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Health Care systems And Policies > Medication Costs and Cost Containment Strategies in the US > Flashcards

Medication Costs and Cost Containment Strategies in the US Flashcards

1
Q

Role of Prescription Drugs (1)

A
  • Curing illness: Examples include antibiotics for infections.
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2
Q

Role of Prescription Drugs (2)

A
  • Controlling chronic illnesses: Includes antihypertensives and antidiabetics.
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3
Q

Role of Prescription Drugs (3)

A
  • Mitigating disease conditions: Examples are anti-rheumatic, anti-cancer, and antiretrovirals.
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4
Q

Role of Prescription Drugs (4)

A
  • Providing symptomatic relief: Includes analgesics and anti-inflammatories.
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5
Q

Problems of Access (1)

A
  • Physical Access: Medications are not physically available.
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6
Q

Problems of Access (2)

A
  • Geographic Access: Medications are available but inaccessible due to transportation issues.
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7
Q

Problems of Access (3)

A
  • Financial Access: Medications are available but unaffordable, leading to incomplete treatment.
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8
Q

Consequences of Non-adherence (1)

A
  • Resistance development: Especially relevant for antimicrobials.
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9
Q

Consequences of Non-adherence (2)

A
  • Accelerated disease progression and complications: Poor adherence can worsen disease outcomes.
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10
Q

Consequences of Non-adherence (3)

A
  • Increased morbidity and mortality: Poor adherence can lead to more severe health issues and higher death rates.
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11
Q

Consequences of Non-adherence (4)

A
  • Increased hospitalizations and re-admissions: Non-adherence often results in more frequent hospital visits.
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12
Q

Factors Driving Prescription Drug Spending (1)

A
  • Increasing utilization: More prescriptions and higher spending per capita.
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13
Q

Factors Driving Prescription Drug Spending (2)

A
  • Price increases: Rising drug prices relative to the Consumer Price Index.
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14
Q

Factors Driving Prescription Drug Spending (3)

A
  • Changes in drug types: New, expensive drugs and loss of patents for generics.
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15
Q

Factors Driving Prescription Drug Spending (4)

A
  • Advertising: Direct-to-consumer and physician advertising increases drug use and costs.
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16
Q

Factors Driving Prescription Drug Spending (5)

A
  • Sales and profitability: Increasing sales and profits of pharmaceutical companies.
17
Q

Factors Driving Prescription Drug Spending (6)

A
  • Corporate greed: Example of Daraprim price increase due to profiteering.
18
Q

Utilization Management Strategies (1)

A
  • Preferred drug lists/formularies: Exclude some drugs from coverage.
19
Q

Utilization Management Strategies (2)

A
  • Step Therapy: Start with cost-effective therapy before moving to more expensive options.
20
Q

Utilization Management Strategies (3)

A
  • Copayments and deductibles: Increase out-of-pocket costs to control spending.
21
Q

Utilization Management Strategies (4)

A
  • Prior Authorization: Require approval for certain medications.
22
Q

Utilization Management Strategies (5)

A
  • Mail order pharmacies: Encourage use for maintenance medications.
23
Q

Utilization Management Strategies (6)

A
  • Restricted pharmacy networks: Limit out-of-network pharmacy use.
24
Q

Utilization Management Strategies (7)

A
  • Prescriber monitoring: Feedback on prescribing patterns to improve cost-effectiveness.
25
Q

Utilization Management Strategies (8)

A
  • Educational interventions: Provide unbiased drug information to prescribers.
26
Q

Negotiating Discounts & Rebates

A
  • Negotiated discounts: Rebates based on sales volume and market share.
27
Q

Purchasing Pools

A
  • Group purchasing: Public and private entities combine to negotiate better drug prices.
28
Q

Generic Substitution Laws (1)

A
  • Mandatory substitution: States require generic substitution unless specified by the prescriber.
29
Q

Generic Substitution Laws (2)

A
  • Non-mandatory substitution: Pharmacists may substitute generics based on professional judgment.
30
Q

Re-designing of State Prescription Forms

A
  • Standardized forms: Promote generic prescribing through standardized and centralized forms.
31
Q

Understanding the Electronic Orange Book (EOB)

A
  • Access EOB online: Search for drug names and check therapeutic equivalence.
32
Q

When Generic Substitution is NOT Recommended

A
  • Narrow Therapeutic Index (NTI) drugs: Avoid substitution due to small margins between effective and toxic doses.
33
Q

Discount Generic Drug Programs

A
  • Retail programs: $4 for 30-day and $10 for 90-day generic prescriptions at some retailers.
34
Q

Pharmaceutical Care

A
  • Responsible drug therapy provision: Aims to improve patient quality of life through effective drug use.

Health Care systems And Policies (5 decks)

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