The program is the first of its kind to combine population health and pharmacoepidemiology in the Houston metropolitan area, one of the nation’s largest and most culturally rich healthcare markets.

“The program positions the UH College of Pharmacy as a hub for advanced training at the intersection of pharmacy, data science and population health,” said Arash Bashirullah, dean of the UH College of Pharmacy. “Graduates will be prepared for research and leadership positions in healthcare systems, government, industry, and academia, and benefit from UH’s Tier One research environment and proximity to the Texas Medical Center.”

Population health shifts the focus from managing illness in individuals to proactively improving health outcomes in specific populations. Pharmacoepidemiology is one of the tools used by population health to study the impact of medications and improve health outcomes in large groups of people. It combines many different fields to study, connecting clinical sciences, data science and epidemiology.

“The program is a timely and strategic initiative that aligns with the growing demand for graduate training in these fields to fill a critical workforce gap while enhancing the college’s educational portfolio,” said Bashirullah. “Houston’s expansive healthcare systems and academic medical centers provide a unique opportunity for the University of Houston to establish leadership in this field.”

The degree track offers students training in epidemiologic methods, biostatistics, health data science and pharmacoepidemiology to generate evidence that informs clinical practice, health policy and healthcare system decision-making.

The new degree tracks will be housed in the Department of Pharmaceutical Health Outcomes and Policy.

“The new program combines the unique strengths of this department with emerging data sciences specialization at UH and the University’s population health initiatives,” said Rajender Aparasu, Mustafa F. & Sanober Lokhandwala Professor and chair of the Department of Pharmaceutical Health Outcomes and Policy.

Applicants to the MS and PhD in Pharmaceutical Sciences with a concentration in Population Health & Pharmacoepidemiology must hold a bachelor’s degree in a relevant field with a minimum GPA of 3.0 on a 4-point scale. Preference is given to applicants with pharmacy, biomedical, or other health-related backgrounds.

How would you summarize your study for a lay audience?

Prescription drugs can be expensive for patients, and many clinicians do not know how to respond when costs are too high. We reviewed the benefits and limitations of seven strategies that clinicians can use to help their patients navigate high-prescription drugs. These include co-payment cards, patient assistance programs, pharmacy coupons, direct-to-consumer pharmacies, public assistance programs, international online pharmacies, and real-time prescription benefit tools. We developed an algorithm covering how to think about the options to help patients afford their medicines based on the patient’s insurance and the drug type (brand-name vs. generic).

What question were you investigating?

Which strategies can clinicians use to help patients facing high prescription drug costs, and when is it appropriate to use each strategy?

What methods or approach did you use?

We performed a comprehensive review of available data and information about each strategy.

What did you find?

We found that co-payment cards can lower out-of-pocket costs for privately insured patients taking brand-name prescription drugs.

For uninsured individuals or those with Medicare Part D who meet financial eligibility criteria, patient assistance or public assistance programs can help to access prescription drugs at reduced costs.

All patients can forgo health insurance and purchase drugs directly using pharmacy coupons or direct-to-consumer pharmacies, which sometimes offer lower prices for generic drugs than out-of-pocket costs with using health insurance.

Online international pharmacies provide a last resort for patients who cannot afford their brand-name drugs and do not qualify for the other strategies.

Prescribers can use real-time prescription drug benefit tools through their electronic health records to estimate patient out-of-pocket costs for prescription drugs and identify alternative lower-cost medicines for insured patients, but these tools can be inaccurate or incomplete.

Finally, some of these strategies, such as copayment cards and patient assistance programs, can raise overall healthcare spending by lowering the barriers to use expensive brand-name prescription drugs even if less expensive alternatives are available.

What are the implications?

We intended this to be a useful publication for both clinicians and patients. It has the potential to help many patients access existing strategies to afford their prescription drugs.

What are the next steps?

This patchwork of strategies to address drug affordability for patients highlights the structural and policy challenges in the current U.S. prescription drug market that impede access to affordable medicines for some patients. Using these strategies may help patients afford medications in the short term, but they do not address the root causes of high drug prices.

Authorship: In addition to Lalani, BWH authors include Catherine S. Hwang, Aaron S. Kesselheim, and Benjamin N. Rome.

Paper cited: Lalani, HS et al. “Strategies to Help Patients Navigate High Prescription Drug Costs” JAMA DOI: 10.1001/jama.2024.17275

Funding: This study was funded by a grant from Arnold Ventures. Hwang received funding support from an institutional T32 National Research Service Award. Kesselheim’s work is funded by the Commonwealth Fund. The work of Kesselheim and Rome is also funded by grants from the Elevance Health Public Policy Institute, the Greenwall Foundation, and the National Academy for State Health Policy.

Disclosures: Kesselheim reported receipt of personal payments from Alosa Health. In addition, Kesselheim reported serving as an expert witness in a case on behalf of a group of state attorneys general and private insurance carriers relating to generic drug pricing, on behalf of a class of plaintiffs against Gilead in a case relating to its tenofovir-containing products, and as an expert with the Federal Trade Commission in the Amgen-Horizon merger case (now settled). No other disclosures were reported.

“While two injectable therapies known as platform injectables, were once the mainstay of multiple sclerosis treatment, our study showed oral therapies became the predominate treatment for multiple sclerosis by 2020,” said Mackenzie Henderson, a postdoctoral researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research (IFH) and the lead author of the study. “Our investigation offers an important step in understanding the evolving treatment landscape for MS among U.S. adults and children.”

The study, published in JAMA Neurology, examined a large and diverse sample of commercially insured adults and children in the United States to evaluate trends in uptake of therapies between 2001 and 2020 for patients with MS, a chronic and progressive neurological disorder and the leading cause of nontraumatic disability among young and middle-aged adults.

In 2000, there were two medications approved for MS treatment in the U.S., but over the past 20 years, more than 10 new medications have been approved, according to researchers.

Research on how these approvals have changed clinical practice has been limited. The Rutgers study shows injectable therapies accounted for nearly 100 percent of medications for MS patients in 2001, but by 2020 that decreased to about 25 percent, with oral therapies rising sharply after their introduction in 2010.

Using commercial claims data from more than 100,000 patients with MS between 2001 and 2020, researchers analyzed injectable, infusion and oral treatment trends. They found that oral medications increased sharply in popularity to become the preferable treatment for MS patients over infusion and injectable treatments. Infusion therapies remained low in uptake, accounting for about 8 percent of therapy initiations in 2020, and platform injectable therapy use declined almost 74 percent throughout the study period, according to researchers.

“Despite the availability and efficacy of infusion therapies for multiple sclerosis, we found that their utilization remained relatively low throughout the study period,” said Chintan Dave, a faculty member at the Center for Pharmacoepidemiology and Treatment Science (PETS) at IFH, an assistant professor with Rutgers Ernest Mario School of Pharmacy and a senior author of the study. “This may be due to several factors contributing to this treatment decision by patients and clinicians, including the preference for more convenient oral therapies, the relatively recent introduction of infusion options, and considerations of safety and cost.”

Researchers said this investigation offers a crucial step in understanding the evolving treatment landscape for MS patients and future research should evaluate the impact of new therapies as they emerge.

Coauthors of the study include Daniel Horton of PETS, Rutgers Robert Wood Johnson Medical School and the Rutgers School of Public Health; Greta Bushnell of PETS and the Rutgers School of Public Health; and Vikram Bhise and Gian Pal of Rutgers Robert Wood Johnson Medical School.

Henderson was the first graduate of Rutgers School of Public Health’s Master of Science in Epidemiology program with a concentration on pharmacoepidemiology.