Classifying medical histories in US Medicare beneficiaries using fixed vs all-available look-back approaches.
Ontology highlight
ABSTRACT:
SUBMITTER: Conover MM
PROVIDER: S-EPMC6417795 | biostudies-literature | 2018 Jul
REPOSITORIES: biostudies-literature
Publications
Classifying medical histories in US Medicare beneficiaries using fixed vs all-available look-back approaches.
Conover Mitchell M MM Stürmer Til T Poole Charles C Glynn Robert J RJ Simpson Ross J RJ Pate Virginia V Jonsson Funk Michele M
Pharmacoepidemiology and drug safety 20180414 7
<h4>Purpose</h4>Evaluate use of fixed and all-available look-backs to identify eligibility criteria and confounders among Medicare beneficiaries.<h4>Methods</h4>We identified outpatient visits (2007-2012) with recently documented (≤180 days) cardiovascular risk and classified patients according to whether the exposure (statin) was initiated within 14 days. We selected each beneficiary's first eligible visit (in each treatment group) that met criteria during the respective look-backs: continuous ...[more]
Similar Datasets
Project description:ImportanceA growing proportion of the population is enrolling in Medicare Advantage (MA), which typically offers additional benefits compared with traditional Medicare (TM).ObjectiveTo determine whether frailty and frailty trajectories differ between MA enrollees and TM enrollees.Design, setting, and participantsThis retrospective cohort study used data from the National Health and Aging Trends Study (2015-2016). Analyses were conducted from August 2023 to March 2024. Participants were community-dwelling Medicare beneficiaries aged 65 years and older.ExposureEnrollment in MA vs TM.Main outcomes and measuresFrailty was calculated by a frailty index (FI) (range, 0-1, with higher values indicating greater frailty) and the Fried Frailty Phenotype (FFP) score (range, 0-5, with higher values indicating greater frailty). Physical performance, including Short Physical Performance Battery (SPPB) score (range, 0-12, with higher values indicating better performance), and gait speed (meters per second) were measured. The primary outcome was the difference in FI and FFP scores from the 2015 baseline assessment to the 2016 follow-up assessment. Secondary outcomes include the 1-year changes in SPPB and gait speed.ResultsThe final cohort consisted of 7063 participants (2775 [23.1%] aged >80 years; 4040 [54.7%] female), representing a sample of the 38.8 million beneficiaries. There were 2583 (35.0%) MA enrollees (13.6 million) and 4480 (65.0%) TM enrollees (25.2 million). At baseline, the FI score was similar between MA and TM enrollees (mean [SD], 0.22 [0.15] vs 0.21 [0.14]), although MA enrollees had worse phenotypic frailty (496 participants [15.2%] vs 811 participants [13.7%] considered frail by FFP score), SPPB scores (mean [SD], 6.91 [3.34] vs 7.21 [3.27]), and gait speed (0.79 [0.24] m/s vs 0.82 [0.23] m/s) than TM enrollees. One year later, there were no differences between MA and TM enrollees in the 1-year change in FI score (mean [SD], 0.016 [0.071] vs 0.014 [0.066]; adjusted mean difference, 0.001 [95% CI, -0.004 to 0.005]), FFP score (mean [SD], 0.017 [1.004] vs 0.007 [0.958]; adjusted mean difference, -0.009 [95% CI, -0.067 to 0.049]), SPPB score (mean [SD], -0.144 [2.064] vs -0.211 [1.968]; adjusted mean difference, 0.068 [95% CI, -0.076 to 0.212]), and gait speed (mean [SD], -0.0160 [0.148] m/s vs -0.007 [0.148] m/s; adjusted mean difference, -0.010 m/s [95% CI, -0.067 to 0.049 m/s]).Conclusions and relevanceIn this cohort study of Medicare beneficiaries from 2015, MA enrollees experienced similar declines in frailty over 1 year compared with TM enrollees. Future work should examine whether the specific types of services covered by health insurance can impact frailty and health trajectories for older adults.
| S-EPMC11365002 | biostudies-literature
Project description:ImportanceMedicare beneficiaries with disabilities aged 18 to 64 years face barriers accessing ambulatory care. Past studies comparing Medicare Advantage (MA) with traditional Medicare (TM) have not assessed how well these programs meet the needs of beneficiaries with disabilities.ObjectiveTo compare differences in enrollment rates, ambulatory care access, and ambulatory care quality for beneficiaries with disabilities in MA vs TM.Design setting and participantsThis cohort study included a nationally representative, weighted sample of 7201 person-years for beneficiaries aged 18 to 64 years with disability entitlement in the Medicare Current Beneficiary Survey from 2015 through 2018. Differences in program enrollment and in measures of access and quality by program enrollment were compared after adjusting for demographic, insurance, social, health, and area characteristics and after reweighting the sample by propensity to enroll in MA as estimated by observed confounders. Data analyses were conducted between November 1, 2020, and November 11, 2021.ExposuresMedicare Advantage vs TM program enrollment.Main outcomes and measuresSix patient-reported measures of ambulatory care access (usual source of care, primary care usual source of care, specialist visit) and quality (cholesterol screening, influenza vaccination, colon cancer screening).ResultsThe mean (SD) age of the overall study population was 52.1 (11.0) years; 49.5% were female and 50.5% were male; 1.6% were Asian/Pacific Islander; 17.4%, Black; 10.2% Hispanic; 1.4%, Native American; 65.1%, White, and 4.2%, multiracial. Among all beneficiaries living in the community, individuals with disability entitlement were less likely to enroll in MA than other beneficiaries (34.8% vs 41.2%). The final sample of beneficiaries with disabilities included 2444 person-years in MA and 4757 person-years in TM. Beneficiaries with disabilities in MA vs TM were more likely to be of a minority race or ethnicity (35.7% vs 27.6%) and less likely to be enrolled in private insurance (11.9% vs 25.0%). Comparing MA with TM among beneficiaries with disabilities, those in MA had significantly better rates of access to a usual source of care (90.2% vs 84.9%; adjusted propensity-weighted marginal difference [APWMD], 2.9%; 95% CI, 0.2%-5.7%), access to specialist visits (53.2% vs 44.8%; APWMD, 5.5%; 95% CI, 0.6%-10.5%), cholesterol screenings (91.1% vs 86.4%; APWMD, 3.8%; 95% CI, 0.9%-6.7%), influenza vaccinations (61.4% vs 51.5%; APWMD, 10.4%; 95% CI, 5.3%-15.5%), and colon cancer screenings (68.4% vs 54.6%; APWMD, 10.3%; 95% CI, 4.8%-15.8%).Conclusions and relevanceIn this cohort study, Medicare beneficiaries with disabilities were enrolled in MA at significantly lower rates than those without disabilities. However, MA was associated with significantly better ambulatory care access and quality for these beneficiaries on 5 of 6 measures compared with TM.
| S-EPMC8903104 | biostudies-literature
Project description:ImportanceAs US hospital expenditures continue to rise, understanding drivers of high-severity billing for hospitalized patients among inpatient physicians is critically important.ObjectiveTo evaluate high-severity billing trends of Medicare beneficiaries treated by hospitalists vs nonhospitalists.Design setting and participantsThis cohort study used Medicare fee-for-service claims of hospitalized patients from 2009 through 2018 to compare the proportion of high-severity billing between general medicine physicians classified as hospitalists vs nonhospitalists across initial, subsequent, and discharge hospital encounters. We compared physicians within the same hospital using hospital fixed effects and adjusted for patient demographics and comorbidities. Changes in the billing practices were assessed by investigating differences in slopes using an interaction term between physician type and time. Analyses were conducted between August 2021 and January 2022.ExposuresTreatment by hospitalists vs nonhospitalists.Main outcomes and measuresHigh-severity billing for initial, subsequent, and discharge hospital encounters.ResultsThe sample included 3 121 260 and 1 855 678 Medicare beneficiaries treated by hospitalists vs nonhospitalists, respectively. In each year, mean age, proportion female, proportion Black and Hispanic dual status, and mean number of chronic conditions were similar among those treated by hospitalists vs nonhospitalists (standardized mean difference < .01). The number of hospitalists grew by 76%, from 23 390 in 2009 to 41 084 in 2018, whereas nonhospitalists decreased by 43.6% (53 758 to 30 289). The proportion of encounters performed by hospitalists increased for the initial hospital encounters (46.3% to 76%), subsequent encounters (46.8% to 76.7%), and discharge encounters (46.1% to 78.5%) over the 10-year period. The proportion of high-severity billing across the hospital, subsequent, and discharge encounters was consistently higher among hospitalists relative to nonhospitalists across all years. Compared with the trends for nonhospitalists, the proportion of high-severity billing grew by 0.46% per year (95% CI, 0.44% to 0.49%; P < .001) for initial encounters, 0.38% per year (95% CI, 0.37% to 0.39%; P < .001) for subsequent encounters, and by 1.1% per year (95% CI, 1.1% to 1.15%; P < .001) for discharge encounters among hospitalists.Conclusions and relevanceIn this cohort study of Medicare fee-for-service beneficiaries treated in hospitals, high-severity billing increased over time for hospital encounters at higher rates for hospitalists than for nonhospitalists. These differences do not appear to be explained by patient complexity. The increase in the number of hospitalists over time may be contributing to rising national costs related to hospital care.
| S-EPMC8933743 | biostudies-literature
Project description:Background: Chronic cough (CC), characterized as a cough lasting >8 weeks, is a common multi-factorial syndrome in the community, especially in older adults. Methods: Using a pre-existing algorithm to identify patients with CC within the 2011-2018 Medicare beneficiaries, we examined trends in gabapentinoid use through repeated cross-sectional analyses and identified distinct utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Individuals without CC but with any respiratory conditions related to cough served as a comparator group. Results: Among patients with CC, gabapentinoid use increased from 18.6% in 2011 to 24.1% in 2018 (p = 0.002), with a similar upward trend observed in the non-CC cohort but with overall lower usage (14.7% to 18.4%; p < 0.001). Patients with CC had significantly higher burdens of respiratory and non-respiratory comorbidities, as well as greater healthcare service and medication use compared to the non-CC cohort. The GBTM analyses identified three distinct gabapentinoid utilization trajectories for CC and non-CC patients: no use (77.3% vs. 84.5%), low use (13.9% vs. 10.3%), and high use (8.8% vs. 5.2%). Conclusions: Future studies are needed to evaluate the safety and effectiveness of gabapentinoid use in patients with refractory or unexplained CC in real-world settings.
| S-EPMC11312945 | biostudies-literature
Project description:ImportanceRoux-en-Y gastric bypass (RYGB) is associated with significant bone loss and may increase fracture risk, whereas substantial bone loss and increased fracture risk have not been reported after adjustable gastric banding (AGB). Previous studies have had little representation of patients aged 65 years or older, and it is currently unknown how age modifies fracture risk.ObjectiveTo compare fracture risk after RYGB and AGB procedures in a large, nationally representative cohort enriched for older adults.Design, setting, and participantsThis population-based retrospective cohort analysis used Medicare claims data from January 1, 2006, to December 31, 2014, from 42 345 severely obese adults, of whom 29 624 received RYGB and 12 721 received AGB. Data analysis was performed from April 2017 to November 2018.Main outcomes and measuresThe primary outcome was incident nonvertebral (ie, wrist, humerus, pelvis, and hip) fractures after RYGB and AGB surgery defined using a combination of International Classification of Diseases, Ninth Edition and Current Procedural Terminology 4 codes.ResultsOf 42 345 participants, 33 254 (78.5%) were women. With a mean (SD) age of 51 (12) years, recipients of RYGB were younger than AGB recipients (55 [12] years). Both groups had similar comorbidities, medication use, and health care utilization in the 365 days before surgery. Over a mean (SD) follow-up of 3.5 (2.1) years, 658 nonvertebral fractures were documented. The fracture incidence rate was 6.6 (95% CI, 6.0-7.2) after RYGB and 4.6 (95% CI, 3.9-5.3) after AGB, which translated to a hazard ratio (HR) of 1.73 (95% CI, 1.45-2.08) after multivariable adjustment. Site-specific analyses demonstrated an increased fracture risk at the hip (HR, 2.81; 95% CI, 1.82-4.49), wrist (HR, 1.70; 95% CI, 1.33-2.14), and pelvis (HR, 1.48; 95% CI, 1.08-2.07) among RYGB recipients. No significant interactions of fracture risk with age, sex, diabetes status, or race were found. In particular, adults 65 years and older showed similar patterns of fracture risk to younger adults. Sensitivity analyses using propensity score matching showed similar results (nonvertebral fracture: HR 1.75; 95% CI, 1.22-2.52).Conclusions and relevanceThis study of a large, US population-based cohort including a substantial population of older adults found a 73% increased risk of nonvertebral fracture after RYGB compared with AGB, including increased risk of hip, wrist, and pelvis fractures. Fracture risk was consistently increased among RYGB patients vs AGB across different subgroups, and to a similar degree among older and younger adults. Increased fracture risk appears to be an important unintended consequence of RYGB.
| S-EPMC6537834 | biostudies-literature
Project description:Background/objectivesNo data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-level linkages between electronic health record (EHR) and claims.DesignIn this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients' medical records from January 2016 to December 2018 and adjudicated dementia status. We measured the accuracy of three claims-based definitions of dementia against the reference standard.SettingMass-General-Brigham Healthcare (MGB), Massachusetts, USA.ParticipantsFrom an eligible population of 40,690 fee-for-service (FFS) Medicare beneficiaries, aged 65 years and older, within the MGB Accountable Care Organization (ACO), we generated a random sample of 1002 patients, stratified by the pretest likelihood of dementia using administrative surrogates.InterventionNone.MeasurementsWe evaluated the accuracy (area under receiver operating curve [AUROC]) and calibration (calibration-in-the-large [CITL] and calibration slope) of three ICD-10 claims-based definitions of dementia against clinician-adjudicated standards. We applied inverse probability weighting to reconstruct the eligible population and reported the mean and 95% confidence interval (95% CI) for all performance characteristics, using 10-fold cross-validation (CV).ResultsBeneficiaries had an average age of 75.3 years and were predominately female (59%) and non-Hispanic whites (93%). The adjudicated prevalence of dementia in the eligible population was 7%. The best-performing definition demonstrated excellent accuracy (CV-AUC 0.94; 95% CI 0.92-0.96) and was well-calibrated to the reference standard of clinician-adjudicated dementia (CV-CITL <0.001, CV-slope 0.97).ConclusionThis study is the first to validate ICD-10 diagnostic codes against a robust and replicable approach to dementia ascertainment, using a real-world clinical reference standard. The best performing definition includes diagnostic codes with strong face validity and outperforms an updated version of a previously validated ICD-9 definition of dementia.
| S-EPMC8373730 | biostudies-literature
Project description:BackgroundEach year, thousands of older adults develop delirium, a serious, preventable condition. At present, there is no well-validated method to identify patients with delirium when using Medicare claims data or other large datasets. We developed and assessed the performance of classification algorithms based on longitudinal Medicare administrative data that included International Classification of Diseases, 10th Edition diagnostic codes.MethodsUsing a linked electronic health record (EHR)-Medicare claims dataset, 2 neurologists and 2 psychiatrists performed a standardized review of EHR records between 2016 and 2018 for a stratified random sample of 1002 patients among 40,690 eligible subjects. Reviewers adjudicated delirium status (reference standard) during this 3-year window using a structured protocol. We calculated the probability that each patient had delirium as a function of classification algorithms based on longitudinal Medicare claims data. We compared the performance of various algorithms against the reference standard, computing calibration-in-the-large, calibration slope, and the area-under-receiver-operating-curve using 10-fold cross-validation (CV).ResultsBeneficiaries had a mean age of 75 years, were predominately female (59%), and non-Hispanic Whites (93%); a review of the EHR indicated that 6% of patients had delirium during the 3 years. Although several classification algorithms performed well, a relatively simple model containing counts of delirium-related diagnoses combined with patient age, dementia status, and receipt of antipsychotic medications had the best overall performance [CV- calibration-in-the-large <0.001, CV-slope 0.94, and CV-area under the receiver operating characteristic curve (0.88 95% confidence interval: 0.84-0.91)].ConclusionsA delirium classification model using Medicare administrative data and International Classification of Diseases, 10th Edition diagnosis codes can identify beneficiaries with delirium in large datasets.
| S-EPMC9588515 | biostudies-literature
Project description:ImportanceAfter the rapid expansion of telemedicine during the COVID-19 pandemic, there is debate about the role and reimbursement of telephone vs video visits. Missing is an understanding of what type of virtual visits clinicians may offer or patients may choose when given the option.ObjectiveTo evaluate characteristics of Medicare beneficiaries associated with practices and clinicians offering telephone visits only and patients receiving telephone visits only, when both telephone and video were available.Design, setting, and participantsThis survey study used 2019-2020 nationally representative Medicare Current Beneficiary Survey data. Participants included community-dwelling Medicare beneficiaries with a usual source of medical care who attended a practice offering telemedicine. Data were analyzed from May 3 to August 23, 2022.Main outcomes and measuresMultivariable regression analysis was used to identify patient sociodemographic (age, sex, race, ethnicity, educational level, income, English proficiency, housing type, and number living at home), clinical (dementia, mental illness, self-rated health, hearing impairment, and vision impairment), and technology (technology access and prior use of video visits) factors associated with respondents' report of (1) practices offering telephone virtual visits only, (2) being offered telephone visits only when both video and telephone visits were available, and (3) receiving telephone visits only when both video and telephone visits were offered.ResultsOf 4691 respondents (representing 27 887 642 Medicare beneficiaries; mean [SD] age, 71.3[8.1] years; 55.0% female) reporting that their practice offered telemedicine, 1234 (23.3% weighted) reported that their practices offered telephone virtual visits only; factors associated with being in a practice offering telephone only included older age (adjusted odds ratio [aOR], 1.62 [95% CI, 1.10-2.39] for those aged ≥85 years vs 18-64 years), male sex (aOR, 1.36 [95% CI, 1.12-1.64]), Hispanic ethnicity (aOR, 1.41 [95% CI, 1.03-1.95]), lower income (aOR, 1.89 [95% CI, 1.43-2.49] for those with income ≤100% vs >200% of the federal poverty level), poor self-rated health (aOR, 1.25 [95% CI, 1.01-1.56]), and less technology access (aOR, 2.05 [95% CI, 1.61-2.60] for those with low vs high access). Of the 1593 patients in practices offering both video and telephone visits, 297 (16.7% weighted) were themselves offered telephone visits only; factors associated with being offered telephone only included Hispanic ethnicity (aOR, 1.96 [95% CI, 1.13-3.41]), limited English proficiency (aOR, 3.05 [95% CI, 1.28-7.31]), and less technology access (aOR, 1.68 [95% CI, 1.00-2.81] for those with low vs high access). Finally, of the 711 respondents who were themselves offered both video and telephone visits, 304 (43.1% weighted) had a telephone visit; factors associated with receiving telephone visits only were older age (aOR, 2.68 [95% CI, 1.21-5.92] for those aged 75-84 years vs 18-64 years) and less technology access (aOR, 2.65 [95% CI, 1.12-6.25] for those with moderate vs high access]). Among those who used video calls in other settings and were offered a choice, 122 (28.5%, weighted) chose telephone visits.Conclusions and relevanceIn this survey study of Medicare beneficiaries, respondents often reported being offered or choosing telephone visits even when video visits were available. Study findings suggest that policy makers and clinical leaders should support the use of telephone visits to the extent that telephone is appropriate, while addressing both practice-level and patient-level barriers to video visits.
| S-EPMC10061240 | biostudies-literature
Project description:ImportanceNonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and structural racism, highlighting the need to understand their receipt of guideline-recommended nonpharmacologic pain therapies, including physical therapy (PT) and chiropractic care.ObjectiveTo assess differences across racial and ethnic groups in receipt of PT or chiropractic care for chronic low back pain (CLBP) among persons with comorbid OUD.Design, setting, and participantsThis retrospective cohort study used a 20% random sample of national Medicare administrative data from January 1, 2016, to December 31, 2018, to identify fee-for-service community-dwelling beneficiaries with a new episode of CLBP and comorbid OUD. Data were analyzed from March 1, 2022, to July 30, 2023.ExposuresRace and ethnicity as a social construct, categorized as American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic, non-Hispanic White, and unknown or other.Main outcomes and measuresThe main outcomes were receipt of PT or chiropractic care within 3 months of CLBP diagnosis. The time (in days) to receiving these treatments was also assessed.ResultsAmong 69 362 Medicare beneficiaries analyzed, the median age was 60.0 years (IQR, 51.5-68.7 years) and 42 042 (60.6%) were female. A total of 745 beneficiaries (1.1%) were American Indian or Alaska Native; 444 (0.6%), Asian or Pacific Islander; 9822 (14.2%), Black or African American; 4124 (5.9%), Hispanic; 53 377 (77.0%); non-Hispanic White; and 850 (1.2%), other or unknown race. Of all beneficiaries, 7104 (10.2%) received any PT or chiropractic care 3 months after a new CLBP episode. After adjustment, Black or African American (adjusted odds ratio, 0.46; 95% CI, 0.39-0.55) and Hispanic (adjusted odds ratio, 0.54; 95% CI, 0.43-0.67) persons had lower odds of receiving chiropractic care within 3 months of CLBP diagnosis compared with non-Hispanic White persons. Median time to chiropractic care was longest for American Indian or Alaska Native (median, 8.5 days [IQR, 0-44.0 days]) and Black or African American (median, 7.0 days [IQR, 0-42.0 days]) persons and shortest for Asian or Pacific Islander persons (median, 0 days [IQR, 0-6.0 days]). No significant racial and ethnic differences were observed for PT.Conclusions and relevanceIn this retrospective cohort study of Medicare beneficiaries with comorbid CLBP and OUD, receipt of PT and chiropractic care was low overall and lower across most racial and ethnic minority groups compared with non-Hispanic White persons. The findings underscore the need to address inequities in guideline-concordant pain management, particularly among Black or African American and Hispanic persons with OUD.
| S-EPMC10498328 | biostudies-literature
Project description:Importance:The United States spends more money on medications than any other country. Most extended-release drugs have not consistently shown therapeutic or adherence superiority, and switching these medications to less expensive, generic, immediate-release formulations may offer an opportunity to reduce health care spending. Objective:To evaluate Medicare Part D and Medicaid spending on extended-release drug formulations and the potential savings associated with switching to generic immediate-release formulations. Design, Setting, and Participants:This cross-sectional study used the 2012 to 2017 Medicare Part D Drug Event and Medicaid Spending and Utilization data sets to analyze 20 extended-release drugs with 37 Medicare formulations and 36 Medicaid formulations. Only cardiovascular, diabetes, neurologic, and psychiatric extended-release drugs saving at most 1 additional daily dose compared with their immediate-release counterparts were included. Extended-release drugs with therapeutic superiority were excluded. Analyses were conducted from January to December 2019. Main Outcomes and Measures:Estimated Medicare Part D and Medicaid savings from switching extended-release to immediate-release drug formulations between 2012 and 2017. Results:Of the 6252 drugs screened for eligibility from the 2017 Medicaid Drug Utilization database and the 2017 Medicare Part D database, 67 drugs with extended-release formulations that were identified in the Medicare data set (20 distinct drugs with 37 formulations [19 brand, 18 generic]) were included in the analysis. In 2017, Medicare Part D spent $2.2 billion and Medicaid spent $952 million (a combined $3.1 billion) on 20 extended-release drugs. Between 2012 and 2017, Medicare Part D and Medicaid spent $12 billion and $5.9 billion, respectively, on extended-release formulations. Switching from brand-name to generic extended-release formulations was estimated to be associated with a $247 million reduction in Medicare spending and $299 million reduction in Medicaid spending in 2017, whereas switching all brand-name and generic extended-release formulations to immediate-release formulations in both Medicare and Medicaid was estimated to reduce spending by $2.6 billion ($1.8 billion for Medicare and $836 million for Medicaid) in 2017. During the study period, the estimated spending reduction associated with switching all patients receiving extended-release formulations (brand name extended-release and generic extended-release) to generic immediate-release formulations was $13.7 billion ($8.5 billion from Medicare and $5.2 billion from Medicaid). Conclusions and Relevance:The findings suggest that switching from extended-release drug formulations to therapeutically equivalent immediate-release formulations when available represents a potential option to reduce Medicare and Medicaid spending.
| S-EPMC7049080 | biostudies-literature