Introduction: Nonadherence to taking prescribed antihypertensive medication (antihypertensive) regimens has been identified as a leading cause of poor blood pressure control among persons with hypertension and an important risk factor for adverse cardiovascular disease outcomes. CDC and the Centers for Medicare and Medicaid Services analyzed geographic, racial-ethnic, and other disparities in nonadherence to antihypertensives among Medicare Part D beneficiaries in 2014. Methods: Antihypertensive nonadherence, defined as a proportion of days a beneficiary was covered with antihypertensives of <80%, was assessed using prescription drug claims data among Medicare Advantage or Medicare fee-for-service beneficiaries aged ≥65 years with Medicare Part D coverage during 2014 (N = 18.5 million). Analyses were stratified by antihypertensive class, beneficiaries' state and county of residence, type of prescription drug plan, and treatment and demographic characteristics. Conclusions and Implications for Public Health Practice: More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes.
Lower adherence to AHM was associated with progressively higher CVD risk. The increase in medication cost from higher AHM adherence was offset solely by reduced Medicaid spending on acute CVD events.
During the warm season, increases in ozone and SO2 concentrations were associated with increased asthma morbidity in children and young adults in Indianapolis. These results will enable reliable estimation of the health impacts of increases in these pollutants on asthma-related ED visits in Indianapolis and similar communities.
Background Hypertension is highly prevalent among the low-income population in the United States. This study assessed the association between Medicaid coverage and health care service use and costs among hypertensive adults following the enactment of the Patient Protection and Affordable Care Act (ACA), by income status level. Methods A nationally representative sample of 2,866 nonpregnant hypertensive individuals aged 18–64 years with income up to 138% of the federal poverty level (FPL) were selected from the 2014 and 2015 Medical Expenditure Panel Survey. Regression analyses were performed to examine the association of Medicaid coverage with outpatient (outpatient visits and prescription medication fills), emergency, and acute health care service use and costs among those potentially eligible for Medicaid by income status—the very low-income (FPL ≤ 100%) and the moderately low-income (100% > FPL ≤ 138%). Results Among the study population, 70.1% were very low-income and 29.9% were moderately low-income. Full-year Medicaid coverage was higher among the very low-income group (41.0%) compared with those moderately low-income (29.1%). For both income groups, having full-year Medicaid coverage was associated with increased health care service use and higher overall annual medical costs ($13,085 compared with $7,582 without Medicaid); costs were highest among moderately low-income patients ($17,639). Conclusion Low-income individuals with hypertension, who were potentially newly eligible for Medicaid under the ACA may benefit from expanded Medicaid coverage by improving their access to outpatient services that can support chronic disease management. However, to realize decreases in medical expenditures, efforts to decrease their use of emergency and acute care services are likely needed.
Objective: Describe the effects of the 2017 Hypertension Guideline (HTN GL) compared to JNC-7 guideline on recommended blood pressure (BP) treatment status among US adults and identify the potential need for expanded clinical- and community-based BP management services. Methods: Analyze data from 2011-2014 National Health and Nutrition Examination Survey, with analytic sample of 10,031 aged ≥18 years. Results: The new HTN GL reclassifies 32.3 million US adults as newly hypertensive and recommends BP-related treatment for 133.7 million adults, including 4.9 million newly recommended pharmacologic therapy and 50.5 million newly recommended lifestyle modifications alone. An estimated 1.1 million adults newly recommended to initiate pharmacologic treatment and 20.6 million adults newly recommended lifestyle modification alone report not having established healthcare linkages. Application of the new HTN GL affects some groups significantly more than others in being reclassified as having hypertension or being newly recommended to initiate BP treatment. This includes adults aged 18-64 years and males, two groups who historically have limited access to or low utilization of healthcare services for hypertension management. In addition, 3.6 million of the 4.9 million US adults who are newly recommended pharmacologic treatment and 36.4 million of the 50.5 million of those newly recommended lifestyle modification alone, are overweight or obese. Conclusions: The new HTN GL results in millions of additional US adults being recommended for lifestyle modification to manage their BP and a smaller proportion for pharmaceutical treatment. With many of those individuals not having established linkages to healthcare, these results can aid in translating the new HTN GL into clinical practice and public health programs necessary to meet the increased demand for services. Expanded clinical and public health resources are likely to be required to manage the additional millions of US adults recommended to newly initiate pharmacologic treatment and/or lifestyle modification, including many who previously had only limited healthcare system interaction. Community-based prevention strategies can aid in addressing this added burden on the health care system.
Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were approved in 2015 for use by adults with familial hypercholesterolemia (FH) or clinical atherosclerotic cardiovascular disease (ASCVD) requiring additional low-density lipoprotein cholesterol lowering beyond use of diet modification and maximally tolerated statin therapy. This study describes the patient, provider and payer related characteristics of prescriptions filled for this new class of injectable medication during 2016. Methods: 2016 quarterly state-level prescription data were obtained from Symphony Health Solution’s PHAST 2.0. PHAST 2.0 includes data on over 90% of prescriptions filled from US retail and mail order pharmacies and, along with market purchasing data, are used to calculate state and national estimates. PCSK9 inhibitor fills among adults aged ≥18 years were characterized by quarter, patient age, provider type, and payer type. Per-capita fill rates across US states and total and patient spending per 30-day supply were calculated. Results: In 2016, 216,082 PCSK9 inhibitor prescriptions were filled. The number of fills per quarter increased from 20,348, in Q1, to 83,812, in Q4, and fill totals were greatest among those aged 65-74 years (39.3% of fills) (Figure). Cardiologists prescribed the majority of fills (60.5%). Commercial payers (43.3%) and Medicare (43.1%) were the most frequent payers. State per-capita fill rates (per 100,000) ranged from 12.1, in WY, to 191.9, in LA (median: 69.1). Total spending per 30-day supply was $951; patient spending was $58 per 30-day supply. Conclusion: Quarterly fills for PCSK9 inhibitors quadrupled during 2016, with substantial variation in per-capita fill rates across states. Cardiologists prescribed the majority of fills, which aligns with their indicated use among adults with FH or ASCVD. Total spending per 30-day supply was considerable. Tracking of prescribing trends for these medications is warranted as additional information about their efficacy becomes available.
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