Patient preferences and willingness-to-pay for Medicare part D consultations offered in a community pharmacy setting
Creators: name: Murry, Logan Thomas
Publisher: name: University of Iowa
Year: 2022
Subjects: decision-making
Medicare Part D
patient-centered
service design
public abstract
Consumer Behavior

description: Introduction: Community pharmacies across the state of Iowa currently offer Medicare Part D consultation services. Despite an increase in plan-switching behavior, potential cost savings, and increased medication adherence resulting from service use, uptake of these services by patients remains low. Objectives: The objectives of this study were to 1) explore patient-centeredness and patient preferences for Medicare Part D consultation service offerings from the perspective of patients. 2) calculate part worth utilities and willingness-to-pay (WTP) for specific service offerings as well as marginal willingness-to-pay (mWTP) for individual service offering attributes, and 3) evaluate the effect of patient-specific factors on optimal service offerings and patient preference for Medicare Part D services.
description: Methods: This was a multi-phase exploratory mixed method study using qualitative interviews and a discrete choice experiment (DCE) survey. Participants for qualitative interviews were recruited by five Iowa CPESN pharmacies and were patients 65 years of age and older who had and had not previously used a Medicare Part D consultation service. A qualitative interview guide was developed using the SERVQUAL framework adapted for healthcare services, with questions focused on Technical, Interpersonal, Administrative, and Environmental quality. Interview transcripts were transcribed and coded using Template analysis, with attributes and levels developed for a (DCE). Qualtrics was contracted to acquire 540 DCE survey responses from individuals who were 65 years of age and older, who currently use one or more prescription medications from a community pharmacy. Demographics and patient-specific factors contributing to patient preference were reported as descriptive statistics. A mixed logit model was used to calculate part-worth utilities for service attributes. To calculate mWTP, the ratio of part-worth utilities to cost was used, with cost treated as a continuous variable. To evaluate patient-specific factors and demographics which may contribute to patient preference for Medicare Part D consultation service offerings, a latent class model was used.
description: Results: In total, 17 interviews were completed (8 service experienced, 9 service naive), with themes identified to design the Qualtrics DCE Survey. The overall themes associated with each SERVQUAL domain were as follows: Technical Quality (), Interpersonal Quality (), Administrative Quality (), and Environmental Quality () In the final DCE instrument, the service attributes that were tested included: Information Provided, Service Location, Service Provider, Service Length, and Price. From the results of the DCE, 540 responses were collected, with the average of respondents being 71 years. For the initial choice task designed as a dominant scenario, 481 respondents (89.07%) selected the dominant choice. Most respondents were female (60%), lived in a Suburban area (56%), used one pharmacy in the past 30 days (76%), were currently taking four or more prescription medication (51%), had previously used a pharmacy service outside of traditional medication dispensing (60%), and most frequently used a chain pharmacy (51%). Overall, self-reported health activation was high with an average of 7.52±1.92. The average scores for the subcomponents of the adapted Medicare Part D health insurance literacy items were 13.9±4.1 and 13.81±2.57, respectively. Service attributes with the highest utility were 15-minute services, discussion of services + a follow-up phone call, In person at the pharmacy, a pharmacist the patient knew, and at no cost. Latent class analysis revealed that patient preferences for service attributes differed by gender and difficulty affording prescription medications.
description: Conclusion: Overall, patients identified pharmacists as potential resources for providing Medicare Part D consultation services, with preferences for specific service attributes. From the DCE survey, patients have specific preferences for service offerings which were quantified using part-worth utilities. Community pharmacies should consider the service attributes associated with utility when considering their Medicare Part D consultation service offerings.