Association Between Prescription Cost Sharing and Adherence to Initial Combination Antiretroviral Therapy in Commercially Insured Antiretroviral-Naïve Patients with HIV

Abstract

• In treatment of human immunodeficiency virus (HIV), high levels of adherence to combination antiretroviral therapy (cART) are required to prevent failure of virologic suppression, development of drug resistance, and permanent loss of therapeutic options. In a study by Maggiolo et al. (2005), the risk of virologic failure was 2.4% in patients with cART adherence of more than 95%, compared with 4.3%, 12.2%, and 17.4% for patients with adherence rates of 86%-95%, 76%-85%, and 75% or less, respectively. World Health Organization guidelines state that adherence of at least 95% is desirable over long periods of time, and studies of newer treatment regimens suggest clinically meaningful adherence thresholds of 85% and 75% for patients treated with proteaseinhibitor (PI)-based and non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens, respectively. • Little is known about the association between cART prescription cost sharing and adherence to cART. Using a questionnaire and conjoint analysis in a sample of 299 highly treatment-experienced patients with HIV/acquired immune deficiency syndrome (AIDS), Stone et al. (2004) found that pill count, dosing frequency, and adverse effects had the greatest impact on perceived ability to adhere to cART; the number of copayments ranked as the seventh most important cART regimen attribute. What is already known about this subjectAssociation

The cascade of HIV care in British Columbia, Canada, 1996–2011: a population-based retrospective cohort study

“…29 The effect of prescription drug cost-sharing on access to antiretroviral therapy in Canada is unclear; higher copayments have been associated with reduced adherence and increased treatment interruption in US settings. 30,31 British Columbia is unique in Canada, because HAART and laboratory and medical monitoring of HIV-infected individuals is universally covered and fully subsidised. Our results are thus likely to represent a best-case scenario, in which individuals are not subject to financial disincentives and state-of-the-art antiretroviral management is consistently recommended and available.…”

Use of Compassionate Supply of Antiretroviral Drugs to Avoid Treatment Interruptions or Delayed Treatment Initiation among HIV-Positive Patients Living in Ontario: A Retrospective Review

“…Financial constraints contribute to medication non-adherence in HIV (Boyer et al 2009;Johnston et al 2012;McAllister et al 2013) and non-HIV (Kennedy and Morgan 2006;Law et al 2012;Tamblyn et al 2014) populations, and non-adherence has been shown to Deborah Yoong et al affect outcomes (Nachega et al 2010;Piette et al 2004). A systematic review found that cost-sharing, such as co-payments or deductibles, by vulnerable populations in high-income countries led to reductions in prescription drug use and associated increases in use of other health services, including hospitalizations (Lexchin and Grootendorst 2004).…”

Assessing the Overall Quality of Health Care in Persons Living with HIV in an Urban Environment

“…The RWP provides funding for the care of uninsured and underinsured PLWH and mandates improvements in the quality of care for PLWH. 6,9,25 In previous studies, uninsured PLWH were less likely to meet HIV-specific measures (retention in care, use of ART, and virologic suppression), [35][36][37][38][39][40][41] and nonprivate insurance was associated with more barriers to care. 42 It would therefore be expected that uninsured PLWH may meet fewer performance measures.…”