October/November 2021 Industry Updates

In a new recommendation from the US Preventive Services Task Force (USPSTF), prescriptions for a daily regimen of low-dose aspirin for most people at high risk of a first heart attack or stroke should no longer be prescribed. This is the first updated recommendation since 2016.

“People ages 40 to 59 who are at higher risk for [cardiovascular disease (CVD)] and do not have a history of CVD should decide with their clinician whether to start taking aspirin,” explained the Task Force. “People aged 60 or older should not start taking aspirin for heart disease and stroke prevention.”

According to the bulletin, the USPSTF explained that although daily aspirin has historically lowered the risk of a first heart attack or stroke, they also found that it can cause harm.

“The most serious potential harm is bleeding in the stomach, intestines, and brain. The chance of bleeding increases with age and can be life-threatening,” they explained.

The new recommendation from the Task Force suggests that once a patient turns age 60 years, they should not take aspirin as a preventative measure. The Task Force said the risk of bleeding outweighs the benefits of preventing heart disease.

The USPSTF explained that new data “shows a closer balance of benefits and harms than previously understood for people in their 50s and that starting aspirin use as young as 40 years old may have some benefit.”

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” said Task Force member John Wong, MD, in the bulletin.

“It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”

Of important note, the new recommendation is only for patients who are at a higher risk of CVD, have no history of CVD, and who are not already taking daily aspirin.

“When deciding whether patients should start taking aspirin to prevent a first heart attack or stroke, clinicians should consider age, heart disease risk, and bleeding risk,” they explained.

“It is also important to consider a patient’s values and preferences. If someone is already taking aspirin and has any questions, they should talk to their clinician about their individual circumstances.” —Julie Gould

Between 2001 and 2018, the overall concentration of health care expenditures in the United States remained strikingly stable, with one exception: a sharp increase in the concentration of prescription drug spending. Researchers reported their findings online in JAMA Network Open.

“In 2001, one-half of all expenditures on prescription drugs were concentrated in 6.0% of the US population,” researchers wrote, “but by 2018, this proportion had decreased to 2.3%.”

The cross-sectional study was based on data collected between 2001 and 2018 from Medical Expenditure Panel Surveys. Researchers were interested in identifying trends in the concentration and distribution of health care expenditures over the period.

The study found that, in any given year, just under 5% of the US population accounted for 50% of health care spending. About 20% of the population fell into the “nonspender” category.

“What is remarkable is that despite more than 2 decades of explicit policy aimed at increasing preventative care with a goal of decreasing the incidence of acute, expensive conditions, these percentiles have hardly changed,” researchers wrote. “This finding is consistent with what Berk and Fang have previously noted and, furthermore, carries over in nearly all population subgroup and expenditure category analyses.”

Regarding prescription drugs, the increase in spending concentration for the category began around 2005 and continued through the analysis’ final year, the study found. The timing coincided with patent expirations and genericization of widely used primary care drugs, such as statins, angiotensin receptor blockers, and selective serotonin reuptake inhibitors, researchers noted. Additionally, the biopharmaceutical industry also pivoted to high-priced specialty drugs with smaller patient populations.

“If this trend continues,” they wrote, “it will have implications for the minimum scale of risk-bearing and drug management needed for health insurance plans to operate efficiently. It will also place constraints on optimal cost-sharing features of insurance products.” —Jolynn Tumolo

Among patients with atopic dermatitis in the United States, Black patients incurred increased out-of-pocket costs across a slate of health care categories. Researchers published their findings online ahead of print in the Archives of Dermatological Research.

“Taken together, these findings underscore the real-world out-of-pocket expense burden faced by Black Americans with atopic dermatitis,” researchers wrote.

To gauge out-of-pocket expenses associated with atopic dermatitis management among Black patients, researchers invited members of the National Eczema Association to participate in a 25-question voluntary online survey. Some 1118 respondents who had atopic dermatitis or cared for someone with the condition met study inclusion criteria.

According to the results, Black patients tended to be younger, live in urban settings, have a lower household income, have Medicaid coverage, and have poor control of atopic dermatitis and frequent skin infections. Compared with patients who were not Black, those who were Black were significantly more likely to report out-of-pocket costs for prescription medications (both covered and not covered by insurance), emergency department visits, and outpatient laboratory testing.

The financial hit from out-of-pocket expenses was also higher among Black patients. Predictors of harmful financial impact included minimally controlled atopic dermatitis, systemic therapy, out-of-pocket expenses that ran more than $200 a month, and Medicaid coverage. Compared with other Black patients or other patients with Medicaid coverage, Black patients with Medicaid coverage had increased odds of a harmful financial impact from out-of-pocket expenses.

“In conclusion, among individuals with atopic dermatitis, [Black individuals reported] increased out-of-pocket expenses in a variety of unique health care categories and significant household financial impact,” researchers wrote. “Additional studies are needed to better understand unique out-of-pocket financial considerations among Black individuals and develop targeted approaches to reduce both the financial and overall burden of atopic dermatitis.”  —Jolynn Tumolo

Neither adherence to asthma controller medications nor asthma exacerbations appeared to change significantly when patients with asthma switched from traditional health plans to high-deductible health plans (HDHPs), according to a study published in JAMA Pediatrics.

“This cohort study found that in a population where medications were exempt from the deductible for most enrollees, HDHP enrollment was associated with minimal or no reductions in controller medication use for children and adults,” researchers wrote, “and no change in asthma exacerbations.”

The longitudinal cohort study included 7275 children and 17,614 adults with persistent asthma who switched to a HDHP. In most, asthma medications were exempt from the deductible and subject to copayments, researchers explained. A matched control group included 45,549 children and 114,141 adults with persistent asthma who stayed in traditional plans.

Children switched to HDHPs showed significant decreases (−0.04 absolute change) in annual 30-day fills for inhaled corticosteroid long-acting β-agonists but not for inhaled corticosteroid or leukotriene inhibitors, the study showed, compared
with children in the control group. Adults switched to HDHPs did not show significant reductions in 30-day fills for any of the asthma controller medications.

The study found no statistically significant differences in controller medication adherence (which researchers measured by proportion of days covered) or asthma exacerbations (measured by rates of oral steroid bursts and asthma-related emergency department visits) for children or adults.

“These findings suggest a potential benefit from exempting asthma medications from the deductible in HDHPs,” researchers advised. —Jolynn Tumolo