Effect of Medicaid Policy Changes on Medication Adherence: Differences by Baseline Adherence

Amin, Krutika; Farley, Joel F.; Maciejewski, Matthew L.; Domino, Marisa Elena

doi:10.18553/jmcp.2017.23.3.337

Cited by 16 publications

(41 citation statements)

References 21 publications

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“…The insti- is considered to more accurately measure adherence than other methods. [14][15][16][17] From the supply diary, we calculated long-term adherence using the proportion of days covered (PDC) measure by dividing the number of days with medication available by the number of days during the 365-day follow-up period (days 1-365). 18 We also calculated adherence in days 31-365 and days 121-365 after the index date as "delayed" adherence outcome assessment periods for secondary analyses.…”

Section: ■■ Methods Data Source and Patient Populationmentioning

confidence: 99%

Predicting Adherence to Chronic Disease Medications in Patients with Long-term Initial Medication Fills Using Indicators of Clinical Events and Health Behaviors

Lauffenburger

Franklin

Krumme

et al. 2018

JMCP

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This work was supported by an unrestricted grant from CVS Health to Brigham and Women's Hospital. Shrank and Matlin were employees and shareholders at CVS Health at the time of this study; they report no financial interests in products or services that are related to this subject. Spettell is an employee of, and shareholder in, Aetna. This research was previously presented at the 2016 Annual Conference of the International Society for Pharmacoepidemiology; August 25-28, 2016; Dublin, Ireland.

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Section: ■■ Methods Data Source and Patient Populationmentioning

confidence: 99%

Predicting Adherence to Chronic Disease Medications in Patients with Long-term Initial Medication Fills Using Indicators of Clinical Events and Health Behaviors

Lauffenburger

Franklin

Krumme

et al. 2018

JMCP

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“…It has been reported that patients in Finland and Sweden were more likely to be non‐adherent for CVD prevention therapy after retirement . Amin et al found a decline in adherence for lipid‐lowering drug and antihypertensive cohorts after North Carolina Medicaid policy changes . Wang et al assessed medication adherence changes after a co‐payment increase for patients who had diabetes, hypertension or both conditions, and found patients with lower comorbidity were more sensitive to co‐payment increase than higher comorbidity patients .…”

Section: Introductionmentioning

confidence: 99%

Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid‐lowering therapy

Warren

Exeter

2019

Pharmacoepidemiology and Drug

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Purpose:We analysed lipid-lowering medication adherence before and after the first hospitalization for cardiovascular disease (CVD) to explore the influence hospitalization has on patient medication adherence. Methods:We extracted a sub-cohort for analysis from 313,207 patients who had primary CVD risk assessment. Adherence was assessed as proportion of days covered (PDC) ≥ 80% based on community dispensing records. Adherence in the 4 quarters (360 days) before the first CVD hospitalization and 8 quarters (720 days) after hospital discharge was assessed for each individual in the sub-cohort. An interrupted time series design using generalized estimating equations was applied to compare the differences of population-level medication adherence rates before and after the first CVD hospitalization. Results: Overall, a significant improvement in medication adherence rate from before to after the hospitalization was observed (odds ratio (OR) 2.49 [1.74-3.57]) among the 946 patients included in the analysis. Patients having diabetes history had a higher OR of adherence before the hospitalization than patients without diabetes (1.50 [1.03-2.22]) but no significant difference after the hospitalization (OR 1.13 [0.89-1.43]). Before the first hospitalization, we observed that quarterly medication adherence rate was steady at around 55% (OR 0.97 [0.93-1.01), whereas the trend in adherence over the post-hospitalization period decreased significantly per quarter (OR 0.97 [0.94-0.99]).Conclusions: Patients were more likely to adhere to lipid-lowering therapy after experiencing a first CVD hospitalization. The change in medication adherence rate is consistent with patients having heightened perception of disease severity following the hospitalization.

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“…This approach of using a uniform denominator of 365 days is a traditional way that has been used by other researchers for assessing medication adherence. [32][33][34] For this analysis, we also adjusted the days supply using drug claims from January to March 2013 in order to account for diabetes drug fills made before the beginning of the preperiod (i.e., April 1, 2013). Any overlapping days supply was adjusted using the same approach as in the primary analysis.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Reduced Drug Copayments on Adherence to Oral Diabetes Medications Among Childless Adults in Wisconsin Medicaid

Kim

Look

2019

JMCP

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BACKGROUND: Medication adherence is an indicator of the quality of drug use, which is associated with better health outcomes and reduced health care expenditures. Drug cost sharing can be a barrier to adherence, especially for low-income individuals with chronic conditions. Most of the existing studies in a Medicaid population have evaluated the effects of increasing drug copayments, but few studies have evaluated the effects of reducing drug copayments on medication adherence. Medicaid coverage for low-income childless adults in Wisconsin was expanded on April 1, 2014, which included reductions in drug copayments and monthly caps on out-of-pocket spending.OBJECTIVE: To evaluate changes in adherence to oral diabetes medications using proportion of days covered (PDC) among Medicaid childless adults with type 2 diabetes after the 2014 Medicaid drug copayment reduction.METHODS: A difference-in-differences design was used to compare the changes in medication adherence between childless adults (treatment group) and parents/caretakers (control group). Wisconsin Medicaid's administrative enrollment records, pharmacy claims, and medical claims data were analyzed. Medication adherence was evaluated for 4 commonly used oral diabetes drug classes (i.e., biguanides, sulfonylureas, dipeptidyl peptidase-IV inhibitors, and thiazolidinediones) by adapting the medication adherence quality measures endorsed by the Pharmacy Quality Alliance. The PDC for all diabetes drugs was calculated among patients who filled ≥ 2 prescriptions for any of the 4 drug classes. PDC for each drug class was also measured among patients who had ≥ 2 drug fills for each drug class. The proportion of adherent patients was evaluated using a threshold of PDC ≥ 0.80. RESULTS: Average PDC for all diabetes drugs was 0.87 in the childless adults at baseline and significantly increased by 0.02 (P = 0.025) relative to the parents/caretakers after the copayment reduction. The baseline proportion of adherent patients (PDC ≥ 0.80) among the childless adults was 76% and significantly increased by 6.2 percentage points (P = 0.003) relative to the control group. The odds of adherence to oral antidiabetic drugs increased by 47%, resulting in the proportion of adherent patients in the childless adults group reaching almost 80% after the coverage expansion. In the per class analyses, a significant effect was found for biguanides; the proportion of adherent patients increased by 5.5 percentage points in childless adults compared with the control group (P = 0.022).CONCLUSIONS: This program evaluation found that a reduction of drug copayments in Wisconsin Medicaid improved the quality of medication use by increasing adherence to oral antidiabetic drugs among childless adults.

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Effect of Medicaid Policy Changes on Medication Adherence: Differences by Baseline Adherence

Cited by 16 publications

References 21 publications

Predicting Adherence to Chronic Disease Medications in Patients with Long-term Initial Medication Fills Using Indicators of Clinical Events and Health Behaviors

Predicting Adherence to Chronic Disease Medications in Patients with Long-term Initial Medication Fills Using Indicators of Clinical Events and Health Behaviors

Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid‐lowering therapy

The Effect of Reduced Drug Copayments on Adherence to Oral Diabetes Medications Among Childless Adults in Wisconsin Medicaid

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