Cost­efficient Treatment Options 1 Running head: COST­EFFICIENT TREATMENT OPTIONS FOR UNINSURED OR 

Cost­efficient Treatment Options for Uninsured or  Underinsured Patients for Five Common Conditions Hemant Sule Presented to Mr. George Langan In Partial fulfillment of Nursing 317 Economics and Nursing School of Nursing Eastern New Mexico University 3/8/2009

Cost­efficient Treatment Options 2 Cost­efficient Treatment Options for Uninsured or Underinsured Patients for Five Common  Conditions Luthy, Karlen, Peterson, Neil, and Wilkinson, Joey presented this article in “Journal for Nurse Practitioners” of October 2008. Karlen E. Luthy, APRN, FNP-c is a family nurse practitioner and assistant professor in community nursing at Brigham Young University in Provo, UT. Neil E. Peterson, BS, RN, is a registered nurse at the Cleveland Clinic in Cleveland, OH. Joey Wilkinson, PharmD, is a clinical pharmacist in the solid organ transplant-liver, kidney, and pancreas unit at LDS Hospital in Salt Lake City, UT. In this article the authors have effectively discussed and analyzed the cost-efficient treatment options for uninsured or underinsured patients for five common conditions and how these options are equally effective in reducing the overall cost of health care and increasing the patient compliance to achieve the desired goal with a specific plan of care, and consequently improving the overall health of this particular strata of patients. The authors have utilized 11 different standard databases to present this information. The article has successfully compared the costs and effectiveness of prescription treatment options for 5 common clinical diagnoses. The Nurse Practitioners play a vital role in providing quality care that continues to develop, concurrent with the ever-evolving health care system. NP must consider additional costs an uninsured or underinsured patient will incur as a result of prescription. We may not think of that the cost of medication, in addition to routine lab tests and regular clinic visits and cost of transportation may really become an unbearable financial burden to the underinsured or uninsured patient, especially during this economic downturn. In August 2006, Wal-Mart launched its $4 dollar generic prescription drug program in Tampa, Florida. In October 2006, the program was expanded to include all Wal-Mart and Sam's Club pharmacies in 14 additional states -- Alaska,

Cost­efficient Treatment Options 3 Arizona, Arkansas, Delaware, Illinois, Indiana, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Texas and Vermont. 314 generic prescription drugs, which comprises for 25 percent of prescriptions are currently dispensed in pharmacies nationwide which is good, especially for uninsured or underinsured patients. For those with health insurance, the typical copay for the 314 generic drugs in Wal-Mart's $4 dollar generic prescription drug program cost between $5 dollars and $10 dollars. While the savings might not seem like much for people with health insurance, the co-payments can add up each month. For those on limited incomes, any savings is welcome relief. For the 46 million uninsured patients who live in one of the 15 states where this program is available, the savings can amount to much more, and may be one of the few times they have been offered a break when it comes to medical costs. There were estimated 90 million uninsured American people under age of 65 in 2007, the number that continues to soar, constantly reaching new records. 37 % of the uninsured do not fill a prescription because of cost alone. The underinsured patients report a similar financial burden of health care like uninsured do. NP’s must maintain a delicate balance between providing quality care and cost-efficient care by prescribing low cost medications. Awareness cost of medication, prescribing the cost-efficient medications, and knowledge of patient assistance programs are valuable tools for NP’s that encourage patient compliance with a specific care regimen. Inability to pay for medication is an established hindrance discouraging a patient’s adherence to a medication treatment plan. In case of specific medication allergy, or a potential drug-to-drug interaction, the NP’s may need to prescribe an expensive medication, if that is the only option. In conclusion, the NP’s need to be vigilant when prescribing the medications, keeping in mind, the costs of medication that can make a difference in patients life and their overall health and the health of nation as a whole, by improving the percentage of people who do not fill them

Cost­efficient Treatment Options 4 due to cost of the medication, which increases their health risks and worsen their medical condition, further increasing the cost of medical treatment. Prescribing low cost medication can also improve the compliance to the treatment plan and improve the overall health of uninsured or underinsured individuals. Wal-Mart has gained popularity by introducing $ 4 prescription program among this class of people as well as NP’s and physicians. The uninsured population in the United States is an issue of public policy concern for several reasons. The lack of health insurance and sometimes inability to afford even $ 4 prescription medications has significant and obvious harmful effects on health of uninsured or underinsured individuals as it reduces compliance to the treatment plan and treatment regimen. Underinsured individuals cannot afford access to the health care system because of their inadequate health insurance coverage requiring costly premiums and high deductibles. I was astonished to look at the tables given in the article for comparison of costs of different medications for just five common conditions. I was shocked at the price differences and so I did little more calculations which are presented in the table below. If we compare all the medications available in the market today and compare their relative price difference including the effectiveness, if we can prescribe the cheaper medication while maintaining quality of care with equally effective medications, it will reduce the cost of today’s health care by 70% to 98%, apply those figures to whooping 90 million uninsured population of the USA, just that will put the United States of America on top of the world in health economics, health statistics and financial stability. Lifestyle modification and weight loss are less costly but most effective therapeutic interventions for some of the common conditions. Drug Cost Comparison for Table 1. Upper Respiratory Infection Drug Zithromax Augmentin Cost In USD 7.66 2.3 Approximate Cost Difference None 70% less

Cost­efficient Treatment Options 5 Trimethoprim-sulfamethoxazole Amoxicillin Table 2. Migraine Headache Drug Imitrex Relpax Midrin Combination of Metoclopramide and Ibuprofen Table 3. Eczema Drug Elidel 1% Cream Triamcinalone 0.1% Cream (midpotency) Triamcinalone 0.025% Cream (low-potency) Table 4. Trichomoniasis Drug Tinidamax ( Tinidazole) Metronidazole Table 5. Polycystic Ovarian Syndrome Drug Actos Avandia Metformin 0.4 0.26 Cost In USD 21 19 0.6 0.32 Cost In USD 2.53 0.11 0.11 Cost In USD 5 0.33 Cost In USD 5.87 3.83 0.66 95% less 96.6% less Approximate Cost Difference None 9.5% less 97.14% less 98.48% less Approximate Cost Difference None 95.65% less 95.65% less Approximate Cost Difference None 93.4% less Approximate Cost Difference None 34.75% less 88.76% less

References Luthy, K., Peterson, N., Wilkinson, J., Cost-efficient Treatment Options for Uninsured or Underinsured Patients for Five Common Conditions, Journal for Nurse Practitioners. 2008;

Cost­efficient Treatment Options 6 4(8):577-584. ©2008 Elsevier Science, Inc. derived from http://www.medscape.com/viewarticle/581260 on 3/8/2009.