Adherence and persistence in patients with rheumatoid arthritis at an integrated health system specialty pharmacy

Peter, Megan; Zuckerman, Autumn D; DeClercq, Josh; Choi, Leena; James, Cameron; Cooper, Katrina; Choi, Jeannie; Nadler, Michael; Tanner, S. Bobo

doi:10.18553/jmcp.2021.27.7.882

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…29-31 However, a recent study assessing DMARD adherence in RA did not find age impacted PDC. 32 Our study is among the first to assess the impact of length of time on therapy on specialty medication adherence. Costello and colleagues 33 reported that of the MS patients that discontinued treatment with interferon beta or glatiramer acetate, nearly half did so within the first 2 years.…”

Section: Discussionmentioning

confidence: 99%

Individual and Community-Level Characteristics and Adherence to Specialty Medications

Kibbons

Moore

Choi

et al. 2022

Journal of Pharmacy Practice

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Background: Understanding risk factors for nonadherence can help specialty pharmacies optimize resources to prevent nonadherence and inform risk-stratification processes. Objective: To determine which individual and community-level characteristics are associated with nonadherence to specialty medications. Methods: We analyzed a cohort of patients enrolled in a prospective randomized controlled trial having filled a specialty medication at least 4 times in the previous 12 months with a proportion of days (PDC) covered < 0.90. We collected patient age, gender, race, medication administration type, therapy start date, home address, insurance type, and online patient portal status from the electronic health record. An ordinal logistic regression model was used to assess the association of nonadherence with individual and community-level patient characteristics. Results: Most patients were female (68%), white (82%), and held commercial insurance (58%) with a median age of 53 (interquartile range [IQR] 40, 64) years. Patients were mostly from the adult rheumatology (35%), multiple sclerosis (20%) and lipid (17%) clinics. Given a 10-year increase in age, patients had lower odds of having lower PDC (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.71-0.94, P = 0.005). Patients on therapy greater than or equal to 1 year had half the odds of having lower PDC relative to patients on therapy less than 1 year (OR = 0.52, CI = 0.35 – 0.75, P < 0.001). No statistically significant associations were found between PDC and gender, race, insurance type, route of administration, clinic type, patient portal status, median income, percent receiving government assistance, or percent with no health insurance. Conclusion: Patients with younger age and shorter duration on treatment may be at-risk for lower adherence. Specialty pharmacies may benefit from targeting adherence interventions to these groups.

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Section: Discussionmentioning

confidence: 99%

Individual and Community-Level Characteristics and Adherence to Specialty Medications

Kibbons

Moore

Choi

et al. 2022

Journal of Pharmacy Practice

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“…High adherence was defined as PDC ≥ 80%. Treatment persistence was defined as being on continuous treatment over time, allowing for a maximum gap of 60 days between treatment refills (where the gap period starts on the last day of treatment supply or drug exposure from the injection and ends at the next prescription refill date) [ 23 , 32 , 33 ].…”

Section: Methodsmentioning

confidence: 99%

Treatment Persistence of Ixekizumab in Adults with Moderate-to-Severe Plaque Psoriasis Participating in the Canadian Patient Support Program

Gulliver

Gooderham

Zhu

et al. 2022

Dermatol Ther (Heidelb)

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Introduction Patients with psoriasis (PsO) should adhere to and be persistent with treatment to maintain disease control. Patient support programs (PSPs) are useful to support patients with disease management. We aimed to understand the real-world patient profile and persistence of ixekizumab-initiating Canadian patients with moderate-to-severe PsO using PSP data. Methods This retrospective observational study was conducted utilizing a Canadian PSP database (May 2016 to March 2020). Inclusion criteria were: age ≥ 18 years with moderate-to-severe PsO, initiated ixekizumab, enrolled in the PSP for ≥ 6 months, and provided informed consent. Psoriasis Area Severity Index (PASI), body surface area (BSA) involvement, and Dermatology Life Quality Index (DLQI) were collected at PSP entry. Adherence [using the proportion of days covered (PDC)] and persistence (using Kaplan–Meier curves) were assessed after 1-year and 2-year follow-ups. Differences in persistence between biologic-naïve and biologic-experienced patients were compared using Cox proportional hazards model after adjusting baseline parameters. Results In total, 1891 ixekizumab-treated moderate-to-severe patients with PsO were included. The mean [standard deviation (SD)] age was 52.3 (13.3) years; 51.1% of patients were 45–65 years old and 61.4% were male. At baseline, the mean (SD) PASI score was 14.3 (8.1), the DLQI score was 16.5 (7.7), and BSA % was 17.4 (15.1). PsO lesions were commonly located on the hands (33.4%), face (28.6%), and feet (23.8%). Ixekizumab-treated patients were highly adherent [PDC ≥ 80%: 1-year (92.0%), 2-year (87.7%)] and persistent [1-year (90.4%), 2-year (85.6%)]. Biologic-naïve patients were more adherent (1-year, 94.6% versus 87.3%; 2-year, 90.3% versus 83.5%) than biologic-experienced patients. Significantly higher persistence in biologic-naïve versus biologic-experienced patients for 1-year ( p < 0.01) and 2-year ( p = 0.010) follow-up periods was observed after adjusting for baseline parameters. Conclusion Patients with moderate-to-severe PsO overwhelmingly remained on ixekizumab treatment for more than 2 years while participating in a PSP.

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“…23 , 25 State and federal payers also vary in pharmacy network adequacy rules that may impact the ability of physician organization–based pharmacies to access payer networks. 26 Nonetheless, industry reports, 27 expert commentary, 28 medical guidelines, 29 surveys, 30 and numerous case studies 31 , 32 , 33 , 34 , 35 , 36 , 37 suggest physician organizations are increasingly launching dispensaries and licensed pharmacies. Recent work has also shown substantial growth in colocated pharmacies integrated with oncology practices, also known as medically integrated dispensing.…”

Section: Introductionmentioning

confidence: 99%

Trends in Integration Between Physician Organizations and Pharmacies for Self-Administered Drugs

Kakani,

Cutler,

Rosenthal

et al. 2024

JAMA Netw Open

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ImportanceIncreasing integration across medical services may have important implications for health care quality and spending. One major but poorly understood dimension of integration is between physician organizations and pharmacies for self-administered drugs or in-house pharmacies.ObjectiveTo describe trends in the use of in-house pharmacies, associated physician organization characteristics, and associated drug prices.Design, Setting, and ParticipantsA cross-sectional study was conducted from calendar years 2011 to 2019. Participants included 20% of beneficiaries enrolled in fee-for-service Medicare Parts A, B, and D. Data analysis was performed from September 15, 2020, to December 20, 2023.ExposuresPrescriptions filled by in-house pharmacies.Main Outcomes and MeasuresThe share of Medicare Part D spending filled by in-house pharmacies by drug class, costliness, and specialty was evaluated. Growth in the number of physician organizations and physicians in organizations with in-house pharmacies was measured in 5 specialties: medical oncology, urology, infectious disease, gastroenterology, and rheumatology. Characteristics of physician organizations with in-house pharmacies and drug prices at in-house vs other pharmacies are described.ResultsAmong 8 020 652 patients (median age, 72 [IQR, 66-81] years; 4 570 114 [57.0%] women), there was substantial growth in the share of Medicare Part D spending on high-cost drugs filled at in-house pharmacies from 2011 to 2019, including oral anticancer treatments (from 10% to 34%), antivirals (from 12% to 20%), and immunosuppressants (from 2% to 9%). By 2019, 63% of medical oncologists, 20% of urologists, 29% of infectious disease specialists, 21% of gastroenterologists, and 22% of rheumatologists were in organizations with specialty-relevant in-house pharmacies. Larger organizations had a greater likelihood of having an in-house pharmacy (0.75 percentage point increase [95% CI, 0.56-0.94] per each additional physician), as did organizations owning hospitals enrolled in the 340B Drug Discount Program (10.91 percentage point increased likelihood [95% CI, 6.33-15.48]). Point-of-sale prices for high-cost drugs were 1.76% [95% CI, 1.66%-1.87%] lower at in-house vs other pharmacies.Conclusions and RelevanceIn this cross-sectional study of physician organization–operated pharmacies, in-house pharmacies were increasingly used from 2011 to 2019, especially for high-cost drugs, potentially associated with organizations’ financial incentives. In-house pharmacies offered high-cost drugs at lower prices, in contrast to findings of integration in other contexts, but their growth highlights a need to understand implications for patient care.

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Adherence and persistence in patients with rheumatoid arthritis at an integrated health system specialty pharmacy

Cited by 13 publications

References 30 publications

Individual and Community-Level Characteristics and Adherence to Specialty Medications

Individual and Community-Level Characteristics and Adherence to Specialty Medications

Treatment Persistence of Ixekizumab in Adults with Moderate-to-Severe Plaque Psoriasis Participating in the Canadian Patient Support Program

Trends in Integration Between Physician Organizations and Pharmacies for Self-Administered Drugs

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