Document Detail

Associations Between Prescription Copayment Levels and β-Blocker Medication Adherence in Commercially Insured Heart Failure Patients 50 Years and Older.
MedLine Citation:
PMID:  21665045     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: High prescription copayments may create barriers to care, resulting in medication nonadherence. Although many studies have examined these associations in commercially insured patients with chronic disease, few have examined β-blocker effects in heart failure patients.
OBJECTIVE: Associations between β-blocker prescription copayment levels and medication nonadherence were examined within commercially insured beneficiaries with a diagnosis of heart failure.
METHODS: Heart failure patients were identified as those with at least 1 inpatient claim or 2 outpatient claims with an associated International Classification of Diagnosis, 9th Edition (ICD-9) code of 428.x, in addition to those with at least 2 β-blocker claims. Copayment levels were defined in using $5.00 (USD) interval categories, and adherence was defined using the medication possession ratio (MPR). Ordinary least squares (OLS), fixed effects (FE), and random effect (RE) models were used to estimate associations between copayment level and MPR. Logistic regression was used to estimate the probability of nonadherence (MPR < 0.80) conditional upon copayment level. Regressions controlled for patient demographics, health status, prior hospitalizations, and concomitant medication use.
RESULTS: The highest β-blocker copayment level ($26+) had an average MPR that was 0.07 (95% CI, -0.11 to -0.03), 0.08 (95% CI, -0.12 to -0.04), and 0.09 (95% CI, -0.17 to -0.02) units lower than β-blocker copayment level ($0 to $1) in the OLS, RE, and FE models, respectively. Copayment levels $21-$25 and $26+ were significantly associated with an increased risk of medication nonadherence (OR = 1.64; 95% CI, 1.1-2.4; and OR = 2.5; 95%, CI 1.6-4, respectively).
CONCLUSIONS: Commercially insured heart failure patients aged ≥50 years who are prescribed higher costing β-blockers may have up to an average 9% decrease in annual β-blocker medication supply as well as an increased risk of nonadherence (MPR <0.80). Results need to be interpreted with caution given the potential of selection bias due to selective prescribing. Associations between copayment levels and nonadherence need to be further explored given the adverse health consequences of nonadherence to β-blockers.
Mark E Patterson; Susan J Blalock; Andrew J Smith; Michael D Murray
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical therapeutics     Volume:  33     ISSN:  1879-114X     ISO Abbreviation:  Clin Ther     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-06-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7706726     Medline TA:  Clin Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  608-16     Citation Subset:  IM    
Copyright Information:
Copyright © 2011. Published by EM Inc USA.
University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri.
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