Mail-order Prescription Research Articles

Pen needle use patterns in an insured population with diabetes: U.S. retrospective claims analysis

BackgroundPeople with diabetes who inject insulin with pen devices may reuse the pen needles (PNs), a practice that can cause PN tip deformity, breakage, and contamination, and that is associated with lipohypertrophy and injection-related pain. ObjectiveThis retrospective study aimed to estimate the extent of PN reuse among people with diabetes in 2 insured populations in the United States. MethodsUsing claims data for Commercial Fully Insured (CFI) and Medicare Advantage (MA) populations from 1-Oct-2018 to 31-Dec-2022, we identified adults with type 1 or type 2 diabetes (T1D/T2D) who had ≥ 1 claim for PNs and ≥ 2 claims for insulin from 1-Jan-2019 to 31-Dec-2021, with continuous medical/pharmacy eligibility for 3 months before first claim and 1 year after (follow-up). Those receiving hospice or palliative care or using mail order prescriptions were excluded. We compared actual annual fill rate of PNs with expected fill rate (assuming single use) according to prescribed insulin regimen. Whether the annual actual-to-expected ratio for PN numbers equaled 1 was evaluated using sign tests with 2-sided P values. ResultsMedian annual actual-to-expected ratios ranged from 0.41 (T1D basal+prandial cohort) to 0.82 (T2D basal cohort; all P < 0.001) in the CFI population (N = 10,854), and from 0.55 (TID basal + prandial) to 1.10 (T2D basal and basal + prandial; P = 0.382-< 0.001) in the MA population (N = 32,495); medians were 0.34 and 0.55 for 4 expected T2D basal + prandial injections/day in CFI and MA populations, respectively (P < 0.001). Annual actual-to-expected ratios were < 1 for 62% and 47% of CFI and MA populations, respectively. An estimated 2%-27% and 0%-17%, respectively, depending on insulin regimen, had inadequate supplies of PNs suggesting that PNs could have been used ≥ 5 times. ConclusionThese findings highlight the need for educating people with diabetes about reasons for avoiding PN reuse and the key role that pharmacists can play in providing this information and adequate supplies of PNs.

Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?

In recent years, 2 circumstances changed provider-patient interactions in primary care: the substitution of virtual (eg, video) for in-person visits and the COVID-19 pandemic. We studied whether access to care might affect patient fulfillment of ancillary services orders for ambulatory diagnosis and management of incident neck or back pain (NBP) and incident urinary tract infection (UTI) for virtual versus in-person visits. Data were extracted from the electronic health records of 3 Kaiser Permanente Regions to identify incident NBP and UTI visits from January 2016 through June 2021. Visit modes were classified as virtual (Internet-mediated synchronous chats, telephone visits, or video visits) or in-person. Periods were classified as prepandemic [before the beginning of the national emergency (April 2020)] or recovery (after June 2020). Percentages of patient fulfillment of ancillary services orders were measured for 5 service classes each for NBP and UTI. Differences in percentages of fulfillments were compared between modes within periods and between periods within the mode to assess the possible impact of 3 moderators: distance from residence to primary care clinic, high deductible health plan (HDHP) enrollment, and prior use of a mail-order pharmacy program. For diagnostic radiology, laboratory, and pharmacy services, percentages of fulfilled orders were generally >70-80%. Given an incident NBP or UTI visit, longer distance to the clinic and higher cost-sharing due to HDHP enrollment did not significantly suppress patients' fulfillment of ancillary services orders. Prior use of mail-order prescriptions significantly promoted medication order fulfillments on virtual NBP visits compared with in-person NBP visits in the prepandemic period (5.9% vs. 2.0%, P=0.01) and in the recovery period (5.2% vs. 1.6%, P=0.02). Distance to the clinic or HDHP enrollment had minimal impact on the fulfillment of diagnostic or prescribed medication services associated with incident NBP or UTI visits delivered virtually or in-person; however, prior use of mail-order pharmacy option promoted fulfillment of prescribed medication orders associated with NBP visits.

The European pharmacy market: the density and its influencing factors

Abstract Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government’s goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters. Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. The research question is: upon which conditions depends the variance in the density of community pharmacies in Europe? So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional health care through pharmacies. I focus on liberal versus regulated market structures, mail-order prescription drug regulation, and third-party ownership consequences. In a panel analysis, the relative influence of the measures is examined across 27 European countries over the last 21 years. The results show that regulated pharmacy markets have over 10.75 pharmacies/100.000 inhabitants more than liberal markets. Further, mail-order prescription drugs decrease the density by -17.98 pharmacies/100.000 inhabitants. Countries allowing third-party ownership have 7.67 pharmacies/100.000 inhabitants more. The results are statistically significant at a 0.001 level. The output of my analysis recommends regulated pharmacy markets, with a ban on mail-order prescription drugs allowing third-party ownership to support nationwide medical health care through community pharmacies. Key messages • Regulated pharmacy markets, with a ban on mail-order of prescription drugs and third-party-ownership have a positive effect on pharmacies density. • The results of my analysis provide the government with measures to improve professional nationwide health care coverage for the population through pharmacies.

Effects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs

Rising drug costs contribute to medication nonadherence and adverse health outcomes. Real-time prescription benefit (RTPB) systems present prescribers with patient-specific out-of-pocket cost estimates and recommend lower-cost, clinically appropriate alternatives at the point of prescribing. To investigate whether RTPB recommendations lead to reduced patient out-of-pocket costs for medications. In this cluster randomized trial, medical practices in a large, urban academic health system were randomly assigned to RTPB recommendations from January 13 to July 31, 2021. Participants were adult patients receiving outpatient prescriptions during the study period. The analysis was limited to prescriptions for which RTPB could recommend an available alternative. Electronic health record data were used to analyze the intervention's effects on prescribing. Data analyses were performed from August 20, 2021, to June 8, 2022. When a prescription was initiated in the electronic health record, the RTPB system recommended available lower-cost, clinically appropriate alternatives for a different medication, length of prescription, and/or choice of pharmacy. The prescriber could select either the initiated order or one of the recommended options. Patient out-of-pocket cost for a prescription. Secondary outcomes were whether a mail-order prescription and a 90-day supply were ordered. Of 867 757 outpatient prescriptions at randomized practices, 36 419 (4.2%) met the inclusion criteria of having an available alternative. Out-of-pocket costs were $39.90 for a 30-day supply in the intervention group and $67.80 for a 30-day supply in the control group. The intervention led to an adjusted 11.2%; (95% CI, -15.7% to -6.4%) reduction in out-of-pocket costs. Mail-order pharmacy use was 9.6% and 7.6% in the intervention and control groups, respectively (adjusted 1.9 percentage point increase; 95% CI, 0.9 to 3.0). Rates of 90-day supply were not different. In high-cost drug classes, the intervention reduced out-of-pocket costs by 38.9%; 95% CI, -47.6% to -28.7%. This cluster randomized clinical trial showed that RTPB recommendations led to lower patient out-of-pocket costs, with the largest savings occurring for high-cost medications. However, RTPB recommendations were made for only a small percentage of prescriptions. ClinicalTrials.gov Identifier: NCT04940988; American Economic Association Registry: AEARCTR-0006909.

Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic

The COVID-19 pandemic disrupted medical care, impacting prescribing of opioid analgesics and buprenorphine for opioid use disorder. Understanding these patterns can help address barriers to care. To evaluate how prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic among both new and existing patients. In this cross-sectional study, use of opioid analgesics and buprenorphine for opioid use disorder from March 18 to September 1, 2020, was projected using a national database of retail prescriptions from January 1, 2018, to March 3, 2020. Actual prescribing was compared with projected levels for all, existing, and new patients. The data include prescriptions to patients independent of insurance status or type and cover 90% of retail prescriptions, 70% of mail-order prescriptions, and 70% of nursing home prescriptions. Prescriptions for opioid analgesics and buprenorphine for opioid use disorder. Outcomes included total number of prescriptions, total morphine milligram equivalents, mean morphine milligram equivalents per prescription, mean dispensed units per prescription, and number of patients filling prescriptions. A total of 452 691 261 prescriptions for opioid analgesics and buprenorphine for opioid use disorder were analyzed for 90 420 353 patients (50 921 535 female patients [56%]; mean [SD] age, 49 [20] years). From March 18 to May 19, 2020, 1877 million total morphine milligram equivalents of opioid analgesics were prescribed weekly vs 1843 million projected, a ratio of 102% (95% prediction interval [PI], 94%-111%; P = .71). The weekly number of opioid-naive patients receiving opioids was 370 051 vs 564 929 projected, or 66% of projected (95% PI, 63%-68%; P < .001). Prescribing of buprenorphine was as projected for existing patients, while the number of new patients receiving buprenorphine weekly was 9865 vs 12 008 projected, or 82% (95% PI, 76%-88%; P < .001). From May 20 to September 1, 2020, opioid prescribing for new patients returned to 100% of projected (95% PI, 96%-104%; P = .95), while the number of new patients receiving buprenorphine weekly was 10 436 vs 11 613 projected, or 90% (95% PI, 83%-97%; P = .009). In this cross-sectional study, existing patients receiving opioid analgesics and buprenorphine for opioid use disorder generally maintained access to these medications during the COVID-19 pandemic. Opioid prescriptions for opioid-naive patients decreased briefly and then rebounded, while initiation of buprenorphine remained at a low rate through August 2020. Reductions in treatment entry may be associated with increased overdose deaths.

Net Spending On Retail Specialty Drugs Grew Rapidly, Especially For Private Insurance And Medicare Part D.

Specialty drugs are expensive, but spending on specialty drugs is difficult to measure because of proprietary rebate payments by manufacturers to insurers, pharmacy benefit managers, and state Medicaid agencies. Our study extends recent research that documented growing use of and spending on specialty drugs by incorporating manufacturer rebates for both public and private payers. Although specialty drugs make up a small portion of retail prescriptions filled, we found that they accounted for 37.7percent of retail and mail-order prescription spending net of rebates in 2016-17. From 2010-11 to 2016-17, spending net of rebates tripled for Medicare Part D beneficiaries and more than doubled for people with private insurance. Medicaid spending net of rebates rose more slowly. These results can help inform decision makers as they strive to balance the costs and benefits of innovative drugs.

Pandemic Has Compromised Mental Health of New Moms

Pandemic Has Compromised Mental Health of New Moms

Postal Service Delays May Affect Mail-Order Prescriptions for Millions of Patients.

Postal Service Delays May Affect Mail-Order Prescriptions for Millions of Patients.

Are patients more adherent to newer drugs?

The annual preventable cost from non-adherence in the US health care system amounts to $100 billion. While the relationship between adherence and the health system, the condition, patient characteristics and socioeconomic factors are established, the role of the heterogeneous productivity of drug treatment remains ambiguous. In this study, we perform cross-sectional retrospective analyses to study whether patients who use newer drugs are more adherent to pharmacotherapy than patients using older drugs within the same therapeutic class, accounting for unobserved heterogeneity at the individual level (e.g. healthy adherer bias). We use US Marketscan commercial claims and encounters data for 2008–2013 on patients initiating therapy for five chronic conditions. Productivity is captured by a drug’s earliest Food and Drug Administration (FDA) approval year (“drug vintage”) and by FDA” therapeutic potential” designation. We control for situational factors as promotional activity, copayments and distribution channel. A 10-year increase in mean drug vintage is associated with a 2.5 percentage-point increase in adherence. FDA priority status, promotional activity and the share of mail-order prescription fills positively influenced adherence, while co-payments had a negative effect. Newer drugs not only may be more effective in terms of clinical benefits, on average. They provide means to ease drug therapy to increase adherence levels as one component of drug quality, a notion physicians and pharmacy benefit managers should be aware of.

Dissecting Drug Pricing in Gastroenterology and Hepatology

In 2018, total health care spending in the United States reached $3.6 trillion dollars, of which $476.2 billion was spent on prescription medications.1 Prescription drug spending continues to rise, increasing 5.5% from 2017 to 2018.1 Retail pharmacy and mail-order prescriptions account for 69.7% of prescription drug spending.1 The system of drug prescribing and distribution involves multiple players and negotiating tools (Supplementary Table 1). Schulman and Dabora2 published a report tracking the flow of funds through 13 different pharmaceutical firms and found that 52% of revenue generated from their pharmaceutical sales was spent on sales promotions.

Implementation of a centralized mail-order pharmacy service.

The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described. The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution. Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.

Abstract P4-14-03: Household net worth is associated with racial disparities in hormonal therapy adherence among women with early stage breast cancer

Abstract Background: Non-adherence to adjuvant hormonal therapy is common and has been associated with both increased copayment amount and black race. Studies suggest controlling for wealth may eliminate racial disparities for a variety of medical condition. We investigated the impact of personal finance on disparities in adherence rates. Patients and Methods: Using de-identified, integrated pharmacy and medical claims data from the Optum insurance claims database, we identified women &amp;gt;50 years old on hormonal therapy for early breast cancer with at least 2 mail order prescription refills between 1/1/07 and 12/31/11. Variables evaluated included demographic and clinical information, annual household income, estimated household net worth (&amp;lt;$250,000, $250,000-750,000, &amp;gt;$750,000), insurance type, and monthly copayment amounts (&amp;lt;$10, $10-20, &amp;gt;$20). Non-adherence was defined as a medication possession ratio &amp;lt;80% of eligible days during a 2-year period. Logistic regression analyses were conducted by sequentially including sociodemographic variables, copayment amount, and each of the economic variables. Due to the strong correlation between net worth and income, and variance of income with age, net worth was included in multivariate models; an additional analysis was done stratifying patients by net worth. Results: We identified 15,522 subjects who initiated hormonal therapy; 25% were non-adherent during the study period. Adherence was 67% with net worth &amp;lt;$25,000 and 81% with net worth &amp;gt;$750,000 (p&amp;lt;0.001). In a univariate analysis, adherence was negatively associated with black race (OR 0.76, p&amp;lt;0.001), advanced age, comorbidity, extent of surgery, Medicare insurance, and higher copayment. Adherence was positively associated with higher household income (OR 1.3, p&amp;lt;0.001) compared to lowest income and with medium net worth (OR=1.26, p&amp;lt;0.001) and higher net worth (OR 1.5, p&amp;lt;0.001) compared to the lowest net worth group. The negative association of black race and adherence (OR 0.76) was reduced by the sequential addition of sociodemographic variables (OR 0.78, p&amp;lt;0.001), copayment (OR 0.80, p=0.004), and net worth (0.87, p=0.08). In the analysis stratified by net worth, black race was no longer associated with decreased adherence. In patients within the high net worth category, high copayment amount was also no longer associated with decreased adherence (OR 1.0, p=0.77). Conclusions: We have shown that financial factors, and in particular net worth, partially explain the lower hormone therapy adherence rate in black women compared to white women. These results suggest economic factors may contribute significantly to disparities in the quality of breast cancer care. Citation Format: Dawn L Hershman, Jennifer Tsui, Jason D Wright, Ellie J Coromilas, Wei Yann Tsai, Alfred I Neugut. Household net worth is associated with racial disparities in hormonal therapy adherence among women with early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-03.

Abstract S3-04: The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early stage breast cancer

Abstract Background: Non-adherence to adjuvant hormonal therapy is common and has been associated with increased copayment amount. We investigated the change in adherence patterns before and after the introduction of generic aromatase inhibitors in 2009. Patients and Methods: Using de-identified, integrated pharmacy and medical claims data from OptumInsight, we identified women &amp;gt;50 years old on hormonal therapy for early breast cancer with at least 2 mail order prescription refills between 1/1/07 and 12/31/11. We categorized hormonal therapy as tamoxifen (TAM), aromatase inhibitor (AI) brand and AI-generic. Variables that were evaluated included demographic and clinical information, household income, number of prescriptions, diagnostic codes, prescription refill dates, provider specialty, coverage type, deductible amount and co-payment amounts. Monthly copayment amount was categorized as &amp;lt;$10, $10-$20, and ≥$20. Non-adherence was defined as a medication possession ratio &amp;lt;80% of eligible days during the first year after initiation. We compared patients who completed their AI prior to July 2009 (pre-generic) to those who initiated after July 2009 (post-generic). Results:We identified 3,351 subjects (1,658 pre-generic; 1,693 post-generic).In the pre-generic cohort, 28.5% took tam and 65.3% took AI-brand for at least 1 year. In the post-generic cohort, there was minimal change in TAM (26.5%); however, only 7.3% remained AI-brand while 67.3% became AI-generic (13.2% switched from brand to generic). Non-adherence increased from 32.7% with copayment &amp;lt;$10/month compared to 44.4% with copayment &amp;gt;$20/month (P&amp;lt;0.0001). For TAM, 62% had a copay &amp;lt;$10 while &amp;lt;1% had a copay &amp;gt;$20; however, for AI brand 75.5% had a copay &amp;gt;$20. There was a non-significant increase in non-adherence of TAM and AI-brand over time. However, non-adherence to AI-brand was 40.3% and AI-generic was lower at 31.4% (P&amp;lt;0.001). In an unadjusted model, AI-brand was associated with decreased adherence (OR = 0.66, P&amp;lt;0.001) and AI-generic was associated with increased adherence ((OR 1.66, P&amp;lt;0.001) compared to TAM. However, in a multivariate model controlling for copayment, only the association between increased adherence with AI-generic (OR 1.65, P&amp;lt;0.001) remained significant. Adherence was also associated with middle-household income (OR 1.37, P&amp;lt;0.01) and high-household income (OR 1.39, P = 0.03) compared to low income. Monthly copayment amount was inversely associated with adherence with $10-$20 (OR = 0.70; P&amp;lt;0.001) and &amp;gt;$20 (OR = 0.49; P&amp;lt;0.001) compared to &amp;lt;$10. In this cohort, adherence was not associated with race, insurance type, age or comorbidity. Conclusions:We found that a higher prescription copayment amount was associated with non-adherence to AI. After controlling for copayment and time, adherence was similar between AI-brand and TAM, but adherence was significantly improved for AI-generic. In addition, other financial factors, such as copayment amount and income, were associated with hormone therapy adherence. Because hormone therapy non-adherence is associated with worse survival outcomes, future public policy efforts should be directed towards reducing financial constraints as a means of increasing the proper use of these life-saving medications. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S3-04.

Prescription patterns for asthma medications in children and adolescents with health care insurance in the United States

Asthma is the most common chronic condition of childhood, and its prevalence has increased over recent decades. However, many children and adolescents with asthma are not being managed in accordance with guideline recommendations. The objective of this study was to analyze prescribing patterns for asthma medications in 6- to 18-yr-olds, with a focus on those aged 6-11 yr. Data from patients enrolled for ≥6 months in PharMetrics were analyzed between June 1, 1995, and September 30, 2008. PharMetrics contains data from 45 million US patients from 85 health care plans, including standard and mail order prescription records. Prescriptions for asthma medication for each patient were recorded. The overall asthma cohort included 659,169 patients; 34,950 (5%) were classified as having severe asthma. The 6- to 11-yr-old subgroup consisted of 374,068 patients (56.7% of the overall asthma cohort). Almost 40% of the population received no medication (severe asthma 1.0%; non-severe asthma 37.6%), with almost identical findings in the 6- to 11-yr-old subgroup. In patients with non-severe and severe asthma, frequency of medication use was as follows: short-acting β(2) -agonists (53% and 92%), oral steroids (23% and 64%), leukotriene receptor antagonists (17% and 49%); inhaled corticosteroids alone (15% and 80%) and in combination with long-acting β(2) -agonists (10% and 22%), respectively. Results for patients in the 6- to 11-yr subgroup were similar to those of the overall cohort. In conclusion, a considerable proportion of children and adolescents with asthma do not receive any asthma medication. Among those who do receive medication, adherence to current guidelines is questionable.

Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer.

Noncompliance with adjuvant hormonal therapy among women with breast cancer is common. Little is known about the impact of financial factors, such as co-payments, on noncompliance. We conducted a retrospective cohort study by using the pharmacy and medical claims database at Medco Health Solutions. Women older than age 50 years who were taking aromatase inhibitors (AIs) for resected breast cancer with two or more mail-order prescriptions, from January 1, 2007, to December 31, 2008, were identified. Patients who were eligible for Medicare were analyzed separately. Nonpersistence was defined as a prescription supply gap of more than 45 days without subsequent refill. Nonadherence was defined as a medication possession ratio less than 80% of eligible days. Of 8110 women younger than age 65 years, 1721 (21.1%) were nonpersistent and 863 (10.6%) were nonadherent. Among 14,050 women age 65 years or older, 3476 (24.7%) were nonpersistent and 1248 (8.9%) were nonadherent. In a multivariate analysis, nonpersistence (ever/never) in both age groups was associated with older age, having a non-oncologist write the prescription, and having a higher number of other prescriptions. Compared with a co-payment of less than $30, a co-payment of $30 to $89.99 for a 90-day prescription was associated with less persistence in women age 65 years or older (odds ratio [OR], 0.69; 95% CI, 0.62 to 0.75) but not among women younger than age 65, although a co-payment of more than $90 was associated with less persistence both in women younger than age 65 (OR, 0.82; 95% CI, 0.72 to 0.94) and those age 65 years or older (OR, 0.72; 95% CI, 0.65 to 0.80). Similar results were seen with nonadherence. We found that higher prescription co-payments were associated with both nonpersistence and nonadherence to AIs. This relationship was stronger in older women. Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.

Abstract S6-4: Association between Prescription Co-Payment Amount and Compliance with Adjuvant Aromatase Inhibitor Therapy in Women with Early Stage Breast Cancer

Abstract Background: Non-adherence to adjuvant hormonal therapy among women with breast cancer is common, but little is known about how financial factors influence it. We investigated the relationship between prescription co-payment amount and compliance with adjuvant aromatase inhibitors (AI) therapy. Patients and Methods: Using de-identified, integrated pharmacy and medical claim database at Medco Health Solutions, Inc. women &amp;gt;50 years old on AIs for early breast cancer with at least 2 mail order prescription refills between 1/1/07 and 12/31/08 were identified. All data were pooled prior to the analysis. Variables that were evaluated included medical and demographic information, household income, number of other prescriptions, diagnostic codes, prescription refill dates, provider type and co-payment amounts. Age was classified as &amp;lt;63 or ≥63 to distinguish patients ever covered by Medicare. Copayment amount was categorized as &amp;lt;$30, between $30 and $89.99, and ≥$90. Non-persistence was defined as prescription supply gap of 45 days with no subsequent refill. Non-adherence was defined as a medication possession ratio ≥80% of eligible days. Logistic regressions and Cox proportional hazards modeling were used. Results: Of 8110 women age 50-62 years (mean=59.1), 1721(21.2%) were non-persistent and of those who continued, 863(10.3%) were non-adherent over the 2 year period. Among 14,050 women ≥63 years (mean=74.9), 3476(24.7%) were non-persistent and of those who continued, 1248(8.9%) were non-adherent. Ninety day co-payments ranged from $0 to $893.49. In a multivariate analysis, non-persistence (ever/never) in both age groups was associated with older age, having a primary care physician write the prescription, and higher number of co-prescriptions. Similar results were seen with non-adherence. Compared to a copayment of &amp;lt;$30, a 90 day copayment of $30-$89.99 was associated with time to non-persistence in women ≥63 (HR 1.34, 95%CI 1.24-1.46) but not among women &amp;lt;63, while a copayment ≥$90 was associated with time to non-persistence both in women &amp;lt;63 (HR 1.26, 95%CI 1.09–1.38) and women ≥63 (HR 1.33, 95%CI 1.22–1.46). Conclusions: We found that a higher prescription co-payment was associated with both early discontinuation and non-adherence to AIs. This relationship was stronger for older women. Because hormone therapy non-compliance is associated with worse survival outcomes, future public policy efforts should be directed towards reducing financial constraints as a means of increasing the use of these life-saving medications. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr S6-4.

Middle‐class America and transplantation: wishin', hopin', thinkin', and prayin'

Middle‐class America and transplantation: wishin', hopin', thinkin', and prayin'

Defense Department sees results on outcomes research

Two years after its launch, the Department of Defense’s Pharmacy Outcomes Research Team, or PORT, is answering questions about how formulary changes affect the health of active-duty and retired service members and their families who receive pharmacy benefits through the military’s Tricare health services program. More than 9.5 million people have outpatient prescription medication benefits through Tricare, according to the program’s website. PORT pharmacoeconomist Shana Trice, speaking March 12 at the 2010 Federal Pharmacy Forum in Washington, D.C., presented data about the effects of a 2005 change in Tricare’s processing of prescriptions for fentanyl transdermal patches. Tricare’s computer system in 2005 began rejecting retail and mail-order prescriptions written for fentanyl patches and issued to patients who had not been prescribed a strong opioid during the previous 60 days. The intent of the change was to prevent opioid-naive patients from receiving the patches, which can be deadly in those who are not opioid tolerant.

Hypertension treatment in a medicare population: Adherence and systolic blood pressure control

Background:Despite substantial trial evidence that demonstrates the effectiveness of pharmacologic treatment for reducing blood pressure (BP) and cardiovascular events, many patients are nonadherent to their hypertension treatment. Objectives:The purpose of this study was to examine patient adherence to hypertension medications using pharmacy data (ie, outpatient, inpatient, and mail-order prescriptions) and the association between adherence measures and systolic BP (SBP) control. Methods:The study included Medicare+Choice beneficiaries (aged ≥ 65 years) who were continuously enrolled in an integrated delivery system in 2003, and who had documented hypertension and received ≥1 hypertension drug in 2002. This analysis used automated clinical data and the 2000 US Census. We estimated 2 measures of hypertension treatment adherence in 2003 using the supply of dispensed drugs in days (proportion of days covered ≥80%): (1) adherence to ≥1 hypertension drug; and (2) adherence to the full hypertension treatment regimen. We defined the regimen by the number of hypertension drugs used concurrently in 2002. We assessed adherence annually and during the 30, 60, and 90 days before an SBP measurement. Logistic regression was used to examine the association between adherence and the number of drugs in the hypertension regimen, as well as the association between adherence and elevated SBP (≥140 mm Hg). We adjusted for patient sociodemographic and clinical characteristics. Results:The majority (52.8%) of patients had multidrug hypertension regimens. In 2003, 87.3% of subjects were adherent to ≥ 1 hypertension drug; 72.1% were adherent to their full regimen. After adjustment, we found that subjects with multidrug regimens were significantly more likely to be adherent to ≥ 1 drug and significantly less likely to be adherent to their full regimen, compared with patients on a 1-drug regimen. Over one-third of subjects had elevated SBP in 2003. Both adherence measures were associated with lower odds of having elevated SBP (eg, odds ratio = 0.87 [95% CI, 0.84–0.89] for adherence to the full regimen). For subjects with multidrug regimens, partial adherence and nonadherence to the regimen were associated with higher odds of having elevated SBP. Conclusions:Adherence measures using automated pharmacy data can identify patients who are nonadherent to their drug treatment regimen and who are more likely to have inadequately controlled BP. Adherence measures that account for the number of drugs in a patients' drug regimen might help identify additional patients at risk for poor BP outcomes due to partial treatment adherence.

How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Preimplementation Prescription Volume and Payment Sources in Rural and Urban Areas

Passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) has created interest in how the legislation will affect access to prescription drugs among rural beneficiaries. Policy attention has focused to a much lesser degree on the implications of the MMA for the financial viability of rural pharmacies. This article presents descriptive information on mail-order prescriptions, volume, and payer type of retail prescriptions in rural vs urban areas. Together, these data provide a baseline for evaluating how implementation of the MMA may affect the financial viability of rural independent pharmacies. Projections of prescriptions dispensed from retail and mail-order pharmacies in 2002 for the total US and a sample of 17 states were obtained from IMS Health. The volume of mail-order prescriptions is small. Rural providers prescribed fewer retail and mail-order prescriptions per person, but more units per person. Rural areas have a higher percentage of prescriptions paid for by cash (18% vs 13%) and Medicaid (16% vs 10%) and a lower percentage of third-party payers than urban areas. Significant variation in volume and payer type exists between states. Rural, independent pharmacies may be negatively affected by MMA implementation as business shifts from cash to third-party reimbursement. The high degree of variation between states also has potentially important implications for the implementation of Prescription Drug Plan regions under MMA.