Moving Branded Statins to Lowest Copay Tier Improves Patient Adherence

Abstract

BACKGROUND: Statins are efficacious in reducing the risk of major cardiovascular events for both primary and secondary prevention, yet long-term adherence is poor. Their effectiveness could be compromised in actual practice when patients are not adherent to the treatments. Higher copayments have been shown to be associated with lower adherence to statins. OBJECTIVE: To assess the effect on patient adherence of moving branded atorvastatin and rosuvastatin from the second to the first tier by a Medicare Part D plan sponsor.METHODS: Pharmacy claims and eligibility records between July 1, 2009, and July 31, 2011, of Medicare Part D members not receiving the lowincome subsidy were analyzed. New atorvastatin and rosuvastatin users in January 2010 (2010 cohort) were compared with those in January 2011 (2011 cohort) after this formulary tier change (tier-reduction group). Adherence was defined by the proportion of days covered (PDC) over 6 months. The impact of tier reduction on adherence was evaluated via logistic regression for binary outcome (PDC≥0.8) and generalized linear regression for continuous PDC by comparing the 2011 cohort with the 2010 cohort, adjusting for demographic and clinical characteristics. Other statin users (97% on generic statins) were also analyzed, serving as a nontierreduction comparator group. RESULTS: We identified 12,437 members in the tier-reduction group. Between the 2010 and 2011 cohorts, mean PDC increased from 0.77 to 0.83, and the proportion of members with high adherence increased from 62.0% to 72.9% (both P < 0.001). After regression adjustment, members in the 2011 cohort were more likely to be adherent (OR=1.68; 95% CI=1.55-1.82) and had a 5.9% increase in PDC (P < 0.05). There was no significant increase in adherence observed in the comparator nontier-reduction group. CONCLUSION: Findings from this study suggest that financial incentives may improve medication adherence. Future studies should evaluate whether such formulary strategies improve long-term adherence and patient outcomes.

Adherence to therapies for secondary prevention of cardiovascular disease: a focus on aspirin

“…Access to medication represents another potential barrier, with payers (e.g., formulary considerations) and national and state governments increasingly influencing which therapies will be reimbursed and to what extent . Additionally, out‐of‐pocket medication costs are a substantial driver of treatment decisions for many patients …”

“…Access to medication represents another potential barrier, with payers (e.g., formulary considerations) and national and state governments increasingly influencing which therapies will be reimbursed and to what extent. 55,56 Additionally, out-of-pocket medication costs are a substantial driver of treatment decisions for many patients. [55][56][57] Finally, many patients do not have well-developed relationships with their healthcare providers or may not be able to effectively communicate their particular symptoms, needs, or challenges.…”

“…55,56 Additionally, out-of-pocket medication costs are a substantial driver of treatment decisions for many patients. [55][56][57] Finally, many patients do not have well-developed relationships with their healthcare providers or may not be able to effectively communicate their particular symptoms, needs, or challenges. 18 Conversely, patient education efforts may be lacking.…”

Paying the price in an era of HIV treatment as prevention: a retrospective study of the cost burden of HIV treatment for people living with HIV in Victoria, Australia

“…12 Studies outside the field of HIV show an association between increased costs and poor adherence. 13,14 and data from lower income countries report decreased adherence to ART was associated with increased costs. 15 Considering the impact of adherence to ART on treatment failure and the development of HIV drug resistance 16 understanding the burden of ART costs represents a potentially critical element to the successful uptake of ART and implementation of TasP strategies.…”

Awareness and Treatment Specifics of Statin Therapy in Persons With Various Cardiovasular Risk: The Study Esse-Rf

“…Стоимость оригинальных статинов достаточно высока. При обследовании >12 тыс пациентов >18 лет показано, что проведенное в условиях реальной практики снижение уровня стоимости брендированных статинов привело к улучшению приверженности [26].…”