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
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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,
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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 co-

pay 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
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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
Cost In Approximate Cost
Drug USD Difference
Zithromax 7.66 None
Augmentin 2.3 70% less
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Trimethoprim-sulfamethoxazole 0.4 95% less

Amoxicillin 0.26 96.6% less
Table 2. Migraine Headache
Cost In Approximate Cost
Drug USD Difference
Imitrex 21 None
Relpax 19 9.5% less
Midrin 0.6 97.14% less
Combination of Metoclopramide and
Ibuprofen 0.32 98.48% less
Table 3. Eczema
Cost In Approximate Cost
Drug USD Difference
Elidel 1% Cream 2.53 None
Triamcinalone 0.1% Cream (midpotency) 0.11 95.65% less
Triamcinalone 0.025% Cream (low-potency) 0.11 95.65% less
Table 4. Trichomoniasis
Cost In Approximate Cost
Drug USD Difference
Tinidamax ( Tinidazole) 5 None
Metronidazole 0.33 93.4% less
Table 5. Polycystic Ovarian Syndrome
Cost In Approximate Cost
Drug USD Difference
Actos 5.87 None
Avandia 3.83 34.75% less
Metformin 0.66 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;
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4(8):577-584. ©2008 Elsevier Science, Inc. derived from

http://www.medscape.com/viewarticle/581260 on 3/8/2009.