Patient Access to Chronic Medications During the COVID-19 Pandemic: Evidence from a Comprehensive Dataset of US Insurance Claims

Jeffrey Clement,Maura Jacobi,Brad Greenwood

doi:10.2139/ssrn.3738323

Abstract

Objective: Patient access and adherence to chronic medications is critical. We evaluated whether disruptions related to COVID-19 affected new and existing patients’ access to pharmacological therapies without interruption.Design: We performed a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients (about 93% of prescriptions dispensed) from May, 2019 through August, 2020. Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts.Results: More prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in dispensing. Compared to the pre-COVIDera, a patient’s likelihood of discontinuing some medications increased after the spread of COVID: norgestrel-ethinyl estradiol (hormonal contraceptive) increased 0.62% (95% CI: 0.59% to 0.65%, pConclusions and Impact: Most US patients were able to access chronic medications during the early months of COVID-19, but still were more likely to discontinue their therapies. Further, fewer than normal new patients started taking crucial medications. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.

Highlights

The SARS-CoV-2 coronavirus pandemic has disrupted supply chains globally and impacted millions of people who rely on uninterrupted access to medications for chronic conditions
As some of this decline may be attributed to diminished need due to social distancing, and diminished nonCovid-19 infections, we focus on chronic medications being used for therapeutic purposes whose need is not expected to decline post-pandemic
The ramp-up of Covid-19 cases and response in the United States began in March, 2020

Summary

Introduction

The SARS-CoV-2 coronavirus pandemic has disrupted supply chains globally and impacted millions of people who rely on uninterrupted access to medications for chronic conditions. We evaluate whether patients in the United States were able to maintain access to selected therapies during the Covid-19 pandemic. With more than 7.3 million workers losing their health insurance, and medical facilities limiting hours for routine visits or closing altogether, there has been a 40% decline in outpatient visits since March 2020 [1, 2]. Pharmacies discouraged patients from stockpiling medication to avoid waste and shortages, the American Society of Health-System Pharmacists estimates there was an 8% increase in the number of active drug shortages during the first quarter of 2020 [3]

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