Cost-Efficient Treatment Options for Uninsured or Underinsured Patients

Abstract and Introduction

The nurse practitioner's (NP's) role in providing quality care continues to evolve, concurrent with the ever-evolving health care system. With an influx of uninsured and underinsured patients, NPs must not only provide high-quality health care, they must also address cost-efficient treatment options for patients who cannot afford expensive medications. Familiarity with the cost of medications and prescribing cost-efficient medications are valuable tools NPs can use to encourage patient compliance with a specific care regimen, consequently improving the overall health of uninsured or underinsured individuals. Knowledge of patient assistance programs may also assist NPs in decreasing prescription drug costs for patients. Cost-efficient treatment options for upper respiratory infection, migraine headache, eczema, trichomoniasis, and polycystic ovarian syndrome are presented.

The number of uninsured Americans continues to soar, reaching a new record high in 2007.^[1] In fact, there was an estimated 90 million uninsured population under the age of 65 for at least part of the 2006-2007 year,^[2] a number that has increased for the sixth year in a row.^[3] Essentially 1 of every 3 Americans has no health insurance.^[4] Unfortunately, current trends report the care provided to uninsured patients will only continue to rise.^[5] The lack of health insurance has significant and detrimental effects on the health of these patients.^[6] The purchase of prescription medications poses a unique challenge for uninsured patients and often promotes noncompliance with the treatment regimen.^[7] In fact, 37% of the uninsured will not fill a prescription because of cost.^[8]

The issue of noncompliance with a treatment regimen is also present within the underinsured population. In fact, underinsured patients report a financial burden of health care similar to uninsured patients.^[9] The term underinsured generally refers to those who cannot afford access to the health care system because their health insurance coverage is inadequate, requiring expensive premiums and high deductibles.^[10] Because inability to pay for medications is an established barrier discouraging a patient's adherence to a medication treatment plan,^[7] cost-efficient methods for treating the underinsured should be considered by the health care provider when prescribing medications. Accordingly, the purpose of this article is to compare the cost and effectiveness of prescription treatment options for 5 common clinical diagnoses: upper respiratory infection, migraine headache, eczema, trichomoniasis, and polycystic ovarian syndrome (PCOS).

Cite this: Cost-efficient Treatment Options for Uninsured or Underinsured Patients For Five Common Conditions - Medscape - Sep 01, 2008.

Drug Comparison for Upper Respiratory Infection
Name^[16]	Dose^[18]	Cost/Treatment^[18]	Cost/Each^[18]
Zithromax	500 mg PO qd × 1 then 250 mg PO qd × 4	$46 for 1 (6 pack) of 250-mg tablets	$7.66
Augmentin	500-125 mg PO bid × 10 days	$46 for 20 (500 mg) tablets	$2.30
Amoxicillin	500 mg PO tid × 10 days	$8 for 30 (500 mg) tablets	$0.26
Trimethoprim-sulfamethoxazole	800 mg/160 mg PO bid × 10 days	$8 for 20 (800 mg/160 mg) tablets	$0.40

Drug Comparison for Upper Respiratory Infection
Name^[16]	Dose^[18]	Cost/Treatment^[18]	Cost/Each^[18]
Zithromax	500 mg PO qd × 1 then 250 mg PO qd × 4	$46 for 1 (6 pack) of 250-mg tablets	$7.66
Augmentin	500-125 mg PO bid × 10 days	$46 for 20 (500 mg) tablets	$2.30
Amoxicillin	500 mg PO tid × 10 days	$8 for 30 (500 mg) tablets	$0.26
Trimethoprim-sulfamethoxazole	800 mg/160 mg PO bid × 10 days	$8 for 20 (800 mg/160 mg) tablets	$0.40

Drug Comparison for Migraine Headache
Name^[16]	Dose^[18]	Cost/Treatment^[18]	Cost/Each^[18]
Imitrex	25-100 mg PO × 1	$189 for 9 (50 mg) tablets	$21
Relpax	20-40 mg PO × 1	$114 for 6 (20 mg) tablets	$19
Acetaminophen/dichloralphenazone/Isometheptene (Midrin)	325/100/65 mg PO × 1 each hour	$18 for 30 (325/100/65 mg) tablets	$0.60
Metoclopramide + ibuprofen	5 mg PO tid prn + 300 mg PO tid prn	$9 for 30 (5 mg) tablets + $10 for 500 (200 mg) tablets	$0.30 + $0.02

Drug Comparison for Migraine Headache
Name^[16]	Dose^[18]	Cost/Treatment^[18]	Cost/Each^[18]
Imitrex	25-100 mg PO × 1	$189 for 9 (50 mg) tablets	$21
Relpax	20-40 mg PO × 1	$114 for 6 (20 mg) tablets	$19
Acetaminophen/dichloralphenazone/Isometheptene (Midrin)	325/100/65 mg PO × 1 each hour	$18 for 30 (325/100/65 mg) tablets	$0.60
Metoclopramide + ibuprofen	5 mg PO tid prn + 300 mg PO tid prn	$9 for 30 (5 mg) tablets + $10 for 500 (200 mg) tablets	$0.30 + $0.02

Drug Comparison for Eczema
Name^[16]	Dose^[18]	Cost/Month^[18]	Cost/Gram^[18]
Elidel 1% Cream	Apply topically to affected area bid	$76 for 1 (30 gm) tube	$2.53
Triamcinalone 0.1% Cream (midpotency for acute inflammation)	Apply topically to affected area qd-qid up to 2 weeks	$9 for 1 (80 gm) tube	$0.11
Triamcinalone 0.025% Cream (low-potency for chronic inflammation)	Apply topically to affected area qd-qid	$9 for 1 (80 gm) tube	$0.11

Drug Comparison for Trichomoniasis
Name^[16]	Dose^[18]	Cost/Treatment^[18]	Cost/Each^[18]
Tinidamax	500 mg: 4 PO × 1 dose	$20 for 4 (500 mg) tablets	$5
Metronidazole	500 mg: 4 PO × 1 dose	$1.33 for 4 (500 mg) tablets	$0.33

Drug Comparison for Polycystic Ovarian Syndrome
Name^[16]	Dose^[18]	Cost/Month^[18]	Cost/Each^[18]
Actos	15-30 mg PO qd	$176 for 30 (30 mg) tablets	$5.87
Avandia	2-4 mg PO bid	$115 for 30 (4 mg) tablets	$3.83
Metformin	500 mg PO qd-tid up to 2000 mg per day	$40 for 60 (500 mg) tablets	$0.66

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