Samara Rosenfeld

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Nearly half of Americans have experienced challenges getting specialty medications, according to the findings of a recent survey by The Harris Poll on behalf of RxBenefits.

Many respondents (24%) reported the top challenge experienced was the overall cost of the medication being too high. Another barrier was the medication not being covered by an employer-provided health plan (16%).

“Specialty drug utilization continues to increase, and is showing no signs of slowing down,” Bryan Statham, chief executive officer of RxBenefits, said in a press release. “In fact, specialty medication costs accounted for over 50% of the total pharmacy spend incurred in 2020. While specialty carve-out has often been touted as an effective method to contain costs, the approach is not effective for employees and can actually cause severe member and service disruption.”

Statham suggested employers go beyond providing a paycheck to attract and retain talent. In fact, a rich benefits package while keeping costs low could lead to a healthier bottom line and more satisfied workforce.

Findings of the survey also revealed Americans aged 18-44 years old were more likely than those at least 45 years old to say they would switch jobs to get coverage if their employer-provided benefits did not cover the coast of their, or a family member’s, specialty medications (19% vs 5%). What’s more those aged 18-44 years old were more likely than those at least 55 years old to say they would involve their company’s human resources department to gain coverage (21% vs 10%).

Still, 73% of Americans surveyed were currently covered by an employer-provided health benefits plan with prescription drug coverage. And 80% said it was important their current or future employer-provided health benefits plan will cover the cost of specialty medications for them or their family.

“The results of this survey further showcase just how important medication coverage is to today’s consumers,” Mark Campbell, Pharm.D., vice president of clinical solutions at RxBenefits, said in the press release. “And while the benefits landscape can certainly be complicated, employers need an advocate that watches out for their financial interests as well as the best health of their employees — someone that helps them understand when something is right and when it’s not.”

The online survey was conducted within the U.S. between June 24-28, 2021, and included more than 2,000 adults at least 18 years old.

Articles

Employees are willing to change jobs to receive better coverage for specialty medications.

49% of Americans Experienced Challenges Getting Specialty Medications

The use of an electronic wearable device did not change hand hygiene compliance among healthcare workers, according to the findings of a new study.

Still, the technology increased the duration of hand rubbing and the volume of alcohol-based handrub used by healthcare workers.

The findings suggested the technology must be further developed and tested.

Daniela Pires, M.D., Ph.D., and colleagues determined whether providing real-time feedback on a simplified hand hygiene action would improve compliance with the World Health Organization’s “5 Moments” and the quality of the hand hygiene action. The open-label, cluster randomized, stepped-wedge clinical trial took place between June 1, 2017 and Jan. 6, 2018. The trial took place in a geriatric hospital of the University of Geneva Hospitals in Sweden. Of those eligible, 97 healthcare workers volunteered to wear a novel electronic wearable device that delivered real-time feedback on hand rubbing duration and application of a hand-sized customized volume of alcohol-based handrub.

The device, dubbed SmartRub, consisted of two elements: a bottle and a wristband. Individual alcohol-based handrub bottle was equipped during the transition and intervention periods with a volumetric flow meter that measured the volume of alcohol-based handrub poured onto the hands. It also provided feedback by vibrating as soon as the predefined volume was applied. The wristband measured the duration of each hand hygiene action and, during the intervention period, vibrated after 15 seconds independently of the hand rubbing duration performed by the healthcare worker.

The study consisted of a baseline, transition, and intervention period. Participants did not wear the device at baseline. The device was worn during the transition period, but the feedback mode (vibration) was not activated, though the device actively monitored the volume of alcohol-based handrub and duration of hand friction for each hand hygiene action. During the intervention period, the feedback mode was activated and monitoring of practices continued. The technology was not worn during the follow-up period.

Hand hygiene compliance was the primary outcome of the study. Additional outcomes included volume of alcohol-based handrub and duration of hand rubbing for each hand hygiene action, along with adherence to device use and frequency of hand hygiene.

Overall, 12 healthcare workers did not fully complete the intervention but were included in the analysis. Nearly 6,900 hand hygiene opportunities were observed during 759 observation sessions. At intervention, hand hygiene compliance (62.9%; 95% CI, 61.1-64.7) was lower than at baseline (66.6%; 95% CI, 64.8-68.4). Hand hygiene compliance was not different between study periods (OR, 1.03; 95% CI, .75-1.42; 

= .85). Factors independently associated with reduced hand hygiene compliance included days since study onset (.997; 95% CI, .994-.998; 

 <.001), older age (OR, .97; 95% CI, .95-.99; 

 = .015), and workload (OR, .29; 95% CI, .2-.41; 

The median volume of alcohol-based handrub and duration of hand rubbing in transition and intervention periods increased from 1.12 (.76-1.68) mL to 1.71 (1.01-2.76) mL and from 6.5 (4.5-10.5) seconds to 8 (4.5-15.5) seconds.

The overall sensitivity of the wearable was 94.1% (95% CI, 91.4-96.2) and the specificity was 99% (95% CI, 97.5-99.7).

The study, “Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene Compliance Among Health Care Workers,” was published online in 

The technology must be further developed and tested to improve hand hygiene compliance.

Wearable Device Does Not Change Hand Hygiene Compliance Among Healthcare Workers

There is no question telehealth use has boomed amid the COVID-19 pandemic. Now, investigators are probing data for patterns of usage that will yield insights into the boom and future use of the technology.

A team of Harvard investigators, including Ateev Mehrotra, a member of the 

editorial advisory board, found 30.1% of all visits were provided through telemedicine and the weekly number of visits increased twenty-three-fold compared with before the pandemic. The team examined the variation in total outpatient visits and telemedicine use across patient demographics, specialties, and conditions in a database of 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020.

Telemedicine use was lower in areas with higher poverty rates (31.9% vs 27.9% for the lowest and highest quartiles of poverty rate).

In rural counties, there was a lower proportion of care performed through telemedicine than in urban counties (23.9% vs 30.7%).

The use of telemedicine varied by specialty, with 68%of visits being with an endocrinologist and 9% being with ophthalmologists.

Other specialties that did not see large spikes of telemedicine visits included optometry (3.3%), physical therapy (6.6%) and orthopedic surgeons (20.7%).

Mental health reasons such as depression (53% of visits), bipolar disorder (55%), and anxiety (53.9%), all resulted in increased telemedicine visits, while 3% of visits were for glaucoma.

Higher usage rates for common conditions were associated with smaller decreases in total weekly visits.

“It is important to interpret these findings in the context of our study population, which disproportionately included employed adults and their family members with commercial insurance. Therefore, these results should be interpreted as conditional on having commercial insurance or a Medicare Advantage plan,” Mehrotra and the team wrote.

Future research may help understand the persistence of such trends over longer periods of time and the impact of the changes on patients’ overall health.

The study, “Outpatient Care During the COVID-19 Pandemic In The United States,” was published in the February issue of 

Trends show how telemedicine has been used during the COVID-19 pandemic.

Exploring Telehealth Trends During COVID-19

Patients with HIV experience worse COVID-19-related outcomes compared to those without the diagnosis, according to new findings.

The findings demonstrated those with HIV had higher rates of severe disease requiring hospitalization relative to patients without HIV, suggesting patients with HIV may need to be recategorized to “increased risk” in the Centers for Disease Control and Prevention’s underlying medical conditions list.

James M. Tesoriero, Ph.D., and colleagues evaluated the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State. The investigators included individuals with confirmed COVID-19 diagnosed between March 1 and June 7, 2020 in New York State. They collected data from the New York State HIV surveillance registry, the New York State Electronic Clinical Laboratory Reporting System, and the State Health Information Network for New York.

The team evaluated COVID-19 diagnoses, hospitalizations, and in-hospital deaths among those living with diagnosed HIV and those living without diagnosed HIV. Among patients with HIV, race/ethnicity, HIV transmission risk at diagnosis, receipt of HIV-related care, stage of HIV infection at last test, and viral load suppression at last test were available.

Nearly 3,000 patients living with diagnosed HIV (70.6% men; 2,409 living in New York City; mean age, 54 years old) were diagnosed with COVID-19. Of those patients, 896 were hospitalized and 207 died in the hospital through the end of the study period. There were similar diagnosis rates between those living with diagnosed HIV and those living without (sRR, .94; 95% CI, .91-.97). Still, those living with diagnosed HIV were hospitalized more than patients living without diagnosed HIV, per population (sRR, 1.38; 95% CI, 1.29-1.47) and among those diagnosed (sRR, 1.47; 95% CI, 1.37-1.56).

The investigators also found an elevated mortality among patients living with diagnosed HIV per population (sRR, 1.23; 95% CI, 1.07-1.4) and among those diagnosed (sRR, 1.3; 95% CI, 1.13-1.48), though not among those hospitalized (sRR, .96; 95% CI, .83-1.09).

For patients living with diagnosed HIV, non-Hispanic Black patients (aRR, 1.59; 95% CI, 1.4-1.81) and Hispanic patients (aRR, 2.08; 95% CI, 1.83-2.37) were more likely to be diagnosed with COVID-19 than White patients. Despite that, those populations were not more likely to be hospitalized once diagnosed with COVID-19 or to die when hospitalized.

The risk of hospitalization increased with progression of the disease to HIV stage two (aRR, 1.29; 95% CI, 1.11-1.49) and stage three (aRR, 1.69; 95% CI, 1.38-2.07).

The findings represented the first population match of an entire U.S. state’s HIV registry against its COVID-19 diagnosis and hospitalization databases, the investigators wrote. The findings suggested those with HIV may warrant recategorization from “might be at increased risk” to “increased risk” in the Centers for Disease Control and Prevention’s underlying medical conditions list. Further, the findings represented an opportunity to address health equity through prevention and treatment approaches.

COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State

The findings suggest patients with HIV should be recategorized to "increased risk" when looking at COVID-19 underlying medical conditions.

HIV Patients Have Worse COVID-19 Outcomes than Counterparts

An increase in drug prices may be coming, according to recent report findings. In fact, in the 

Vizient Winter 2021 Pharmacy Market Outlook

, results projected a 2.67% increase in the price of pharmaceuticals purchased by health systems, academic medical centers, pediatric hospitals, and non-acute practices from July 1 to June 30, 2022.

Further findings demonstrated an overall increase for oncology spend, a potential increase in cancer mortality due to the impact of COVID-19 on screenings and the pandemic’s impact on plasma-derived products.

“The trend toward more moderate drug price increases is a welcome one, given the financial difficulties created by the pandemic,” Dan Kistner, Pharm.D., group senior vice president, pharmacy solutions for Vizient, said in 

. “Even so, without question the pandemic continues to have an impact on clinical and financial outcomes. Increased use of high-cost drugs vasopressin and tocilizumab as well as many critical care drugs used to treat COVID patients are continuing to impact budgets.”

A recent FDA approval of vasopressin caused the price to spike significantly, according to the press release. But there are substantial price decreases projected for other drugs including injectable acetaminophen, daptomycin, and regadenoson. Adalimumab is the drug with the largest anticipated price increase and is used to treat arthritis and ulcerative colitis. The drug is projected to increase in price by 7.5% over the next 18 months as biosimilar competition cannot yet be marketed.

According to the report, oncology medications which make up 24.67% of pharmaceutical purchases are expected to increase 2.68%. Additionally, screening rates for breast, colon, and cervical cancer reduced dramatically since April, which led to a 65.2% decline in the incidence of new cancer diagnoses. Such could lead to mortality increases up to 9.5% from breast cancer and up to 16.6% for colorectal cancer within five years.

Vizient expects supply of plasma-derived products to tighten in the first quarter of 2021 due to the reduction of plasma donations and concerns about contracting COVID-19.

What’s more, biosimilars may make their biggest impact in the next five years, according to the report. There are 29 FDA-approved biosimilars with more yet to be launched. Biosimilars resulted in cost savings of $19 billion between 2015-2019. Such savings are expected to increase to $104 billion by 2024.

“It’s not yet possible to determine the total expense associated with COVID-19 on the health care industry. We know that spend on COVID-related drugs began to decline in the second quarter of last year, but we saw an uptick of $60.5 million over five of the most commonly used COVID-related drugs in the third quarter of 2020 compared to the same quarter in 2019,” Kistner concluded.

COVID-19 May Continue to Impact Healthcare Costs

Rates of initiation of glucagonlike peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and dipeptidyl peptidase-4inhibitors (DPP-4i) are lower among Medicare Advantage enrollees than commercial health insurance plan enrollees.

The findings suggested a need to better understand nonclinical factors contributing to the treatment selection and efforts to promote equity in diabetes management.

Rozalina G. McCoy, M.D., M.S., and a team of investigators compared trends in the initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage plans compared with commercial plans. They assessed deidentified administrative claims data from OptumLabs Data Warehouse or medical and pharmacy claims and enrollment records for commercial insurance plan and Medicare Advantage enrollees.

McCoy and colleagues included all enrollees with type 2 diabetes aged 58 to 66 years old who filled any medication prescription to lower glucose levels from Jan. 1, 2016 to Dec. 31, 2019. Among those in the GLP-1RA, SGLT2i, and DPP-4i groups, the index date was the first prescription fill for a drug in each class that was preceded by a 12-month period of uninterrupted coverage without a fill for any drug in the same class. For other patients, index was the first prescription fill of any drug preceded by 12 months of uninterrupted coverage.

Three separate logistic regression models were used to calculate the odds of initiating GLP-1RA, SGLT2i, and DPP-4i treatment.

The team identified more than 382,000 adults with pharmacologically treated type 2 diabetes, of whom, 172,180 were Medicare Advantage enrollees and 210,394 were commercial beneficiaries. Over the three-year study period, adjusted rates of initiation for a medication to lower glucose levels increased among all beneficiaries from 2.14% to 20.02% for GLP-1RA among commercial insurance beneficiaries and from 1.5% to 11.44% among Medicare Advantage beneficiaries. Rates increased from 2.74% to 18.15% for SGLT2i among commercial insurance beneficiaries and from 1.57% to 8.51% among Medicare Advantage beneficiaries, and from 3.3% to 11.71% for DPP-4i among commercial insurance beneficiaries and 2.44% to 7.68% among Medicare Advantage beneficiaries.

The team found initiation rates among all three drug classes were lower among Medicare Advantage than commercial insurance beneficiaries.

Within each calendar year of the three-year study period, the odds of initiating GLP-1RA treatment ranged from .28 (95% CI, .26-.29) to .70 (95% CI, .65-.75) for Medicare Advantage and commercial insurance beneficiaries, respectively. Odds varied in the SGLT2i cohort from .21 (95% CI, .2-.22) to .57 (95% CI, .53-.61), respectively; and DPP-4i, from .37 (95% CI, .34-0.39) to .73 (95% CI, .69-.78), respectively (

Income was a factor that led to the increased use of GLP-1RA and SGLT2i.

It is important to better understand nonclinical factors contributing to treatment decisions in diabetes management, the investigators concluded.

Comparison of Diabetes Medications Used by Adults With Commercial Insurance vs Medicare Advantage, 2016 to 2019

Commercial health insurance plan enrollees are more likely to take glucose-lowering medications.