{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T03:38:36Z","timestamp":1747193916953,"version":"3.40.5"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>The burden from medication costs for treating heart failure can be financially toxic for uninsured\/underinsured patients and their families. Prescription discount cards, which offer cash price reductions, may decrease out-of-pocket costs for patients without prescription benefits, but the degree to which they offer financial relief remains unclear. Our objective was to assess the financial burden for uninsured\/underinsured patients prescribed a drug from each of the 4 standard classes of medications for heart failure with reduced ejection fraction. A second objective assessed whether discounts varied across economically and geographically diverse regions in Tennessee.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>This was a cross-sectional pricing analysis of guideline-directed medical therapy heart failure with reduced ejection fraction regimens utilizing prescription discount cards. Between February 9 and March 31, 2022, we conducted searches on 3 discount card websites (GoodRx, NeedyMeds, and Blink Health) for the prices of 30- and 90-day supplies of select guideline-directed medical therapy heart failure regimens for 6 Tennessee ZIP codes. Prices were compared with Amazon and Redbook prices.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Monthly costs among discount card services varied from $10.58 to $30.86 for a generic 3-drug regimen consisting of beta blockers, angiotensin-converting enzyme inhibitors\/angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. With the addition of a sodium-glucose cotransporter-2 inhibitor, prices increased to $540.32 to $593.74. The ideal 4-drug regimen (beta blocker, angiotensin receptor neprilysin inhibitor, mineralocorticoid receptor antagonist, and sodium-glucose cotransporter-2 inhibitor) ranged from $1188.31 to $1464.54. When compared with Amazon cash prices, the cards offered an average discount of 65% on a generic 3-drug regimen; when brand-name medications were added, discounts were modest (&lt;12%). There were no significant variations in pricing based on ZIP codes in differing economic and geographic regions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Although prescription discount cards offered significant savings on generic medications, brand-name drug discounts were small and overall costs remained high. These findings highlight the potential for unequal access to life-saving therapies for heart failure with reduced ejection fraction.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.123.009987","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T18:00:56Z","timestamp":1697565656000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Prescription Drug Discount Cards and Out-of-Pocket Costs for HFrEF Regimens"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3440-9659","authenticated-orcid":true,"given":"James S.","family":"Wheeler","sequence":"first","affiliation":[{"name":"University of Tennessee College of Pharmacy, (J.S.W., A.D., K.M.P.) Knoxville, TN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert E.","family":"Heidel","sequence":"additional","affiliation":[{"name":"Graduate School of Medicine, (R.E.H.) Knoxville, TN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie","family":"Dong","sequence":"additional","affiliation":[{"name":"University of Tennessee College of Pharmacy, (J.S.W., A.D., K.M.P.) Knoxville, TN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine M.","family":"Pleines","sequence":"additional","affiliation":[{"name":"University of Tennessee College of Pharmacy, (J.S.W., A.D., K.M.P.) Knoxville, TN."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9044-5614","authenticated-orcid":true,"given":"Paul J.","family":"Hauptman","sequence":"additional","affiliation":[{"name":"University of Nevada, Reno School of Medicine (P.J.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2017.01.003"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.12.012"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.464"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.5033"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.2223"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.20969"},{"key":"e_1_3_3_8_2","unstructured":"US Department of Health and Human Services. New HHS report shows national uninsured rate reached all-time low in 2022. 2022. Accessed June 14 2023. https:\/\/www.hhs.gov\/about\/news\/2022\/08\/02\/new-hhs-report-shows-national-uninsured-rate-reached-all-time-low-in-2022.html"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.022164"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.6955"},{"key":"e_1_3_3_11_2","unstructured":"Consumer Reports. Consumer reports drugstore survey finds substantial price differences for commonly prescribed drugs. 2015. Accessed February 2 2022. https:\/\/www.consumerreports.org\/media-room\/press-releases\/2015\/12\/consumer-reports-drugstore-survey-finds-substantial-price-differences-for-commonly-prescribed-drugs\/"},{"key":"e_1_3_3_12_2","first-page":"444","article-title":"Availability and variation of publicly reported prescription drug prices.","volume":"23","author":"Kullgren JT","year":"2017","unstructured":"Kullgren, JT, Segel, JE, Peterson, TA, Fendrick, AM, Singh, S. Availability and variation of publicly reported prescription drug prices. Am J Manag Care. 2017;23:444\u2013448.","journal-title":"Am J Manag Care"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1138"},{"key":"e_1_3_3_14_2","unstructured":"IBM Micromedex Redbook. Accessed September 1 2022. https:\/\/www.ibm.com\/products\/micromedex-red-book\/resources"},{"key":"e_1_3_3_15_2","unstructured":"Amazon Pharmacy. Accessed September 1 2022. https:\/\/pharmacy.amazon.com\/how-it-works"},{"key":"e_1_3_3_16_2","unstructured":"Map of 25 poorest zip codes in Tennessee based on average adjusted gross income. Accessed September 1 2022. https:\/\/www.zipdatamaps.com\/economics\/income\/agi\/state\/poorest-zipcodes-in-tennessee"},{"key":"e_1_3_3_17_2","unstructured":"Map of 25 wealthiest Zip codes in tennessee based on average adjusted gross income. Accessed September 1 2022. https:\/\/www.zipdatamaps.com\/economics\/income\/agi\/state\/wealthiest-zipcodes-in-tennessee"},{"key":"e_1_3_3_18_2","unstructured":"Health Resources and Services Administration. Defining Rural Populations. Accessed September 1 2022. https:\/\/www.hrsa.gov\/rural-health\/about-us\/definition\/index.html."},{"key":"e_1_3_3_19_2","unstructured":"GoodRx. Accessed September 1 2022. https:\/\/www.goodrx.com\/"},{"key":"e_1_3_3_20_2","unstructured":"NeedyMeds. Find help with the cost of medicine. Accessed September 1 2022. https:\/\/www.needymeds.org\/"},{"key":"e_1_3_3_21_2","unstructured":"BlinkHealth. Accessed September 1 2022. https:\/\/www.blinkhealth.com\/"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.053291"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00051"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.5542"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.7.780"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/virtualmentor.2014.16.4.ecas2-1404"},{"key":"e_1_3_3_27_2","first-page":"21","article-title":"A pharmacist\u2019s primer on prescription drug discount cards.","volume":"46","author":"Hilas O","year":"2021","unstructured":"Hilas, O. A pharmacist\u2019s primer on prescription drug discount cards. US Pharm. 2021;46:21\u201323.","journal-title":"US Pharm"},{"key":"e_1_3_3_28_2","unstructured":"Dr Christina Polomoff discusses the complex world of medication discount cards. Am J Manag Care. Accessed September 1 2022. https:\/\/www.ajmc.com\/view\/dr-christina-polomoff-discusses-the-complex-world-of-medication-discount-cards"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2014.001406"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.7.953"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.33188"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.010635"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0198173"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2018.24.12.1260"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.7326\/M22-0756"},{"key":"e_1_3_3_36_2","unstructured":"Toussaint J; Harvard Business Review. Why haven healthcare failed. 2021. Accessed September 1 2022. https:\/\/hbr.org\/2021\/01\/why-haven-healthcare-failed"},{"key":"e_1_3_3_37_2","unstructured":"Medicare.gov. Costs in the coverage gap. Accessed February 2 2022. https:\/\/www.medicare.gov\/drug-coverage-part-d\/costs-for-medicare-drug-coverage\/costs-in-the-coverage-gap"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.123.009987","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T03:21:21Z","timestamp":1715570481000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.123.009987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":36,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.123.009987"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.123.009987","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"type":"print","value":"1941-7713"},{"type":"electronic","value":"1941-7705"}],"subject":[],"published":{"date-parts":[[2023,10]]},"assertion":[{"value":"2023-02-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}