title: Out-of-pocket costs and prescription reversals with oral linezolid.
abstract: OBJECTIVE
  To determine the relationship between benefit design, out-of-pocket costs, and prescription reversals, and the impact of reversals on rehospitalizations and total healthcare costs among Medicare members prescribed oral linezolid.
  
  
  METHODS
  Medicare members from a national health plan prescribed oral linezolid posthospitalization for skin and soft tissue infection (SSTI) or pneumonia were followed retrospectively.
  
  
  METHODS
  Members were identified by an oral linezolid prescription between June 1, 2007, and April 30, 2011, where the index event was a prescription fill or reversal less than 2 days before or 10 days after discharge. Associations between out-of-pocket costs and reversal, and between reversal and rehospitalization 30 days postindex, were compared for prescription fills versus reversals. A generalized linear model calculated adjusted total healthcare costs per member controlling for age, sex, geographic region, and clinical characteristics.
  
  
  RESULTS
  Reversal rates rose progressively from 2% for members with out-of-pocket costs of $0 to 27% for members with out-of-pocket costs higher than $100 (P < .0001). Infection-related rehospitalizations were 23% versus 9% for members with a prescription reversal versus a fill (P < .0001). While postdischarge prescription drug costs were $1228.78 lower (P <.0001), adjusted mean medical costs were $2061.69 higher (P = .0033) and total healthcare costs were $1280.93 higher (P = .0349) for reversal versus fill members.
  
  
  CONCLUSIONS
  Higher out-of-pocket costs were associated with higher rates of reversal, and reversals were associated with higher rates of rehospitalization and adjusted total healthcare costs among Medicare members prescribed oral linezolid posthospitalization for SSTI or pneumonia.
authors.affiliation: Principal Researcher, Comprehensive Health Insights, Inc, 325 W Main St, WFP6W, Louisville, KY 40202. E-mail: mpasquale@humana.com.
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Pasquale
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Louder
authors.forename: Michael C
authors.initials: MC
authors.lastname: Deminski
authors.forename: Richard B
authors.initials: RB
authors.lastname: Chambers
authors.forename: Seema
authors.initials: S
authors.lastname: Haider
mesh_terms: D000081:Acetamides / Q000191:economics* / Q000627:therapeutic use; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use; D016208:Databases, Factual; D057915:Drug Substitution / Q000191:economics*; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations; D006801:Humans; D016014:Linear Models; D000069349:Linezolid; D054524:Medicare Part D; D008875:Middle Aged; D023303:Oxazolidinones / Q000191:economics* / Q000627:therapeutic use; D010359:Patient Readmission; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000188:drug therapy; D014481:United States; D055815:Young Adult
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid