The effect of insurance-driven medication changes on patient care

Mark N. Rood, Wanda Cruz-Knight, James Cunagin, Stephen J. Zyzanski, James J. Werner, Mary Jane Mason, Peter J. Lawson, Kurt C. Stange, Sue Flocke

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose▶ Insurance plans periodically change their formularies to enhance medical efficacy and cost savings. Patients face challenges when formulary changes affect their treatment. This study assessed the impact of insurance-driven medication changes on primary care patients and examined implications for patient care. Methods▶ We mailed questionnaires to a cross-sectional random sample of 1200 adult patients who had visited one of 3 family medicine practices within the past 6 months, asking them to describe problems they had encountered in filling medication prescriptions. We performed descriptive analyses of the frequency and distribution of demographic variables and conditions being treated. Using logistic regression analysis, we identified demographic and health-related variables independently associated with patient-reported problems caused by formulary changes. Results▶ Three variables - a greater number of prescription medications taken, younger patient age, and reliance on government insurance - were independently associated with an increased likelihood of encountering a problem filling a medication. Patients who reported an insurance-related issue filling a new or existing prescription over the past year (23%) encountered an average of 3 distinct problems. Patients experienced adverse medical outcomes (41%), decreased satisfaction with the health care system (68%), and problems that burdened the physician practice (83%). Formulary changes involving cardiac/hypertension/lipid and neurologic/psychiatric medications caused the most problems. Conclusions▶ Insurance-driven medication changes adversely affect patient care and access to treatment, particularly for patients with government insurance. A better understanding of the negative impact of formulary changes on patient care and indirect health care expenditures should inform formulary change practices in order to minimize cost-shifting and maximize continuity of care.

Original languageEnglish (US)
JournalJournal of Family Practice
Volume61
Issue number7
StatePublished - Jul 1 2012
Externally publishedYes

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Insurance
Formularies
Patient Care
Prescriptions
Cost Allocation
Demography
Delivery of Health Care
Continuity of Patient Care
Family Practice
Cost Savings
Health Expenditures
Nervous System
Psychiatry
Primary Health Care
Logistic Models
Regression Analysis
Medicine
Hypertension
Physicians
Lipids

ASJC Scopus subject areas

  • Family Practice

Cite this

Rood, M. N., Cruz-Knight, W., Cunagin, J., Zyzanski, S. J., Werner, J. J., Mason, M. J., ... Flocke, S. (2012). The effect of insurance-driven medication changes on patient care. Journal of Family Practice, 61(7).

The effect of insurance-driven medication changes on patient care. / Rood, Mark N.; Cruz-Knight, Wanda; Cunagin, James; Zyzanski, Stephen J.; Werner, James J.; Mason, Mary Jane; Lawson, Peter J.; Stange, Kurt C.; Flocke, Sue.

In: Journal of Family Practice, Vol. 61, No. 7, 01.07.2012.

Research output: Contribution to journalArticle

Rood, MN, Cruz-Knight, W, Cunagin, J, Zyzanski, SJ, Werner, JJ, Mason, MJ, Lawson, PJ, Stange, KC & Flocke, S 2012, 'The effect of insurance-driven medication changes on patient care', Journal of Family Practice, vol. 61, no. 7.
Rood MN, Cruz-Knight W, Cunagin J, Zyzanski SJ, Werner JJ, Mason MJ et al. The effect of insurance-driven medication changes on patient care. Journal of Family Practice. 2012 Jul 1;61(7).
Rood, Mark N. ; Cruz-Knight, Wanda ; Cunagin, James ; Zyzanski, Stephen J. ; Werner, James J. ; Mason, Mary Jane ; Lawson, Peter J. ; Stange, Kurt C. ; Flocke, Sue. / The effect of insurance-driven medication changes on patient care. In: Journal of Family Practice. 2012 ; Vol. 61, No. 7.
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