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Objective. To estimate the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. Data Sources/Setting. Electronic health records from a large, health care delivery system for 223,730 patients with diabetes prescribed 842,899 new cardiometabolic medications during 2006-2012. Study Design. Observational, new prescription cohort study of the effect of OOP cost on medication initiation and adherence. Data Collection. Adherence and OOP costs were based on pharmacy dispensing records and benefits. Principal Findings. Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index; 7 percent were never dispensed the new medication when OOP cost [greater than or equal to]$11, 5 percent with OOP cost of $1-$10, and 3 percent when the medication was free of charge (p < .0001). Higher OOP cost was also strongly associated with inadequate secondary adherence ([greater than or equal to]20 percent of time without adequate medication). There was no clinically significant or consistent relationship between OOP costs and early nonpersistence (dispensed once, never refilled) or later stage nonpersistence (discontinued within 24 months). Conclusions. Cost-sharing may deter clinically vulnerable patients from initiating essential medications, undermining adherence and risk factor control. Key Words. Adherence, medical expenditures, pharmacy benefits, out-of-pocket costs, As a strategy to control expenditures and excessive use of services, insurers and health care delivery systems typically require patients to bear an out-of-pocket (OOP) cost (in the form of [...]

Background. The specialist&apos;s role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential. Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices. Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction. Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction. Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction. Key Words. Satisfaction, quality of care, managed care, financial incentives Patient satisfaction with medical care is an important component in assessing the quality of care. Studies have found that satisfaction is associated with patient compliance with provider recommendations, willingness to initiate malpractice litigation, switching providers and health plans, and medical care utilization (Sherbourne et al. 1992; Vaccarino 1977; Marquis, Davies, and Ware 1983; Newcomer, Preston, and Harrington 1996; Zastowny, Roghmann, and Cafferata 1989)., The published literature suggests that practice characteristics, including practice size, provider capitation, and certain forms of utilization review, are associated with patient satisfaction with primary care (Rubin et al. 1993; [...]