The American journal of managed care
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Many patients struggle to take their prescription medications as prescribed. Multiple interacting factors influence medication nonadherence. The cost of medications, particularly a patient's out-of-pocket cost, spans several of these domains. ⋯ Medication rebates play an important role in the current US pharmaceutical marketplace. However, rebate contract terms are not publicly reported, so it is difficult for patients to determine if, and how, a rebate is reflected in their out-of-pocket costs. This commentary addresses the role of rebates in the current US healthcare landscape and their relationship with medication adherence.
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To examine inaccuracies in health plan provider directories and consider whether the machine-readable (MR) formats required of provider directories in the health insurance exchanges are more accurate than conventional directories and have the potential to improve directory accuracy in the future. ⋯ The MR provider directories are not more accurate than the conventional provider directories. However, there is strong reason to believe that MR technology can be leveraged to increase accuracy. Promising state- and vendor-led initiatives also have the potential to correct widespread provider directory inaccuracy.
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Although improving the average patient experience is at the center of recent efforts to make cancer care more patient centered, extreme experiences may be more informative for quality improvement. Little is known about the most deeply dissatisfying experiences that predispose disengagement and negatively influence patient outcomes. We sought to establish a framework for emotionally adverse patient experiences and identify the range of common causes. ⋯ This study presents a taxonomy for classifying emotionally adverse patient experiences expressed in free-text format. Further research should test how perceptions of adverse experiences correspond to recorded ratings of patient satisfaction and subsequent enrollment or utilization.
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Despite data suggesting that patient-centered medical homes (PCMHs) improve preventive service use, limited nationally representative evidence exists. This study compared preventive service use between patients with and without a usual source of care (USC) and, of the patients with a USC, between those in practices with and without PCMH status. ⋯ Having a USC was associated with higher rates of several preventive screening measures. However, there were fewer significant preventive screening relationships by PCMH status among individuals with a USC. Our results suggest that improving access to a USC may be as important as the application of PCMH principles to a USC practice.
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Maintaining glycemic control limits costly health risks in patients with type 2 diabetes (T2D), but accomplishing this may require individualized strategies. Generic medications (eg, sulfonylureas [SU], insulin) are common in T2D management due to their efficacy and costs; however, relatively new drug classes (eg, dipeptidyl peptidase 4 [DPP-4] inhibitors, sodium-glucose cotransporter 2 [SGLT2] inhibitors) have demonstrated clinical benefits in combination therapy. The objective of this study was to evaluate the long-term cost-effectiveness of a strategy involving branded combination therapy with DPP-4 inhibitors and SGLT2 inhibitors (pathway 1) compared with a generic alternative with SU and insulin (pathway 2) on a background of metformin. ⋯ In the United States, sequential addition of SGLT2 inhibitors to DPP-4 inhibitors may be considered cost-effective compared with traditional treatment with generic medications for patients who fail to achieve glycemic goal on metformin.