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March 08, 2017

By Gary A. Puckrein, PhD

Out-of-Pocket Payments Issue Brief


Concern exists that African Americans seeking treatment for heart failure cannot afford the fixed-dose combination of hydralazine hydrochloride and isosorbide dinitrate (BiDil). Some physicians therefore have expressed reluctance to prescribe this FDA-approved therapy. A recent study by the National Minority Quality Forum has found that in 2013 the median out-of-pocket payment per tablet by African American Medicare beneficiaries for whom the therapy was indicated was $0.06, and 25% of them had no out-of-pocket expenditure for the medication. Optimal daily dosage is six tablets. Among these eligible patients who were prescribed the optimal dosage, 50% were paying out of pocket $0.36 or less per day and 75% were paying $2.00 or less per day.

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