Association of Copayment with Likelihood and Level of Adherence in New Users of Statins: A Retrospective Cohort Study

Watanabe, Jonathan H.; Kazerooni, Rashid; Bounthavong, Mark

doi:10.18553/jmcp.2014.20.1.43

Cited by 20 publications

(16 citation statements)

References 29 publications

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“…The Patient Protection and Affordable Care Act of 2010 (ACA) required that private insurers provide first-dollar coverage for services and medications with an "A" or "B" grade from the USPSTF without cost-sharing for primary prevention. [43][44][45] Some insurers responded by reducing the out-of-pocket costs for certain generic statins to zero regardless of indication. 46 Lower out-ofpocket costs have been associated with increased prescription fills for and adherence to statin ther- apy, 43,47 which have been subsequently associated with a reduction in rates of major cardiovascular events among those with a prior myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

et al. 2019

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Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in the United States. The purpose of this study is to examine the rates of statin use for secondary prevention of ASCVD events in the United States over the last decade and determine whether disparities in the treatment of ASCVD still persist among women and racial/ethnic minorities. Methods: We conducted a trend analysis using data from 2008 through 2016 to describe age-adjusted trends in the use of statins for secondary prevention using the Medical Expenditure Panel Survey. We also conducted a multivariable logistic regression analysis to determine whether sociodemographic characteristics are associated with statin use during the 3 years that followed the publication of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline (2014 through 2016). Results: The prevalence of statin use among those with a history of ASCVD remained unchanged from 2008 through 2016. In 2014 to 2016, more than 40% of those aged 40 years and older with a history of ASCVD did not use statins, corresponding to approximately 9.5 million Americans. Increasing age and having been diagnosed with high cholesterol (odds ratio [OR], 6.22; P < .001) were associated with higher odds of statin use while being female (OR, 0.65; P < .001) or Hispanic (OR, 0.69; P ‫؍‬ .011) were associated with lower odds of statin use. Conclusions: Our study found there was no increase in the national rates of statin use following the ACC/AHA 2013 secondary prevention guideline and the availability of generic statins. Significant gender and ethnic disparities in ASCVD treatment remained in the United States.

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Section: Discussionmentioning

confidence: 99%

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

et al. 2019

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“…For example, Watanabe and colleagues reported that among new statin users, patients who did not pay out-of-pocket costs had a nearly 20 % increased odds of compliance (MPR ≥ 0.80) relative to patients with any out-of-pocket costs. 5 Although patients saved an average of $20 per 30-day supply of statin therapy, we have previously shown that this cohort of switchers is as compliant as patients who remain on branded statins. 28 Importantly, while patients who switched had marked reductions in statin costs, savings for all medication regimens were on average only $5 per month and may not have been large enough to influence compliance.…”

Section: Discussionmentioning

confidence: 93%

“…Numerous studies have shown that lower prescription copayments correlate with better compliance with statin therapy. [2][3][4][5]27 However, to our knowledge, these studies were not conducted in populations switching from branded to generic agents. For example, Watanabe and colleagues reported that among new statin users, patients who did not pay out-of-pocket costs had a nearly 20 % increased odds of compliance (MPR ≥ 0.80) relative to patients with any out-of-pocket costs.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Statin Compliance after Switching from Branded to Generic Agents among Managed-Care Beneficiaries

Romanelli

Segal

2014

J GEN INTERN MED

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OBJECTIVES:To identify patient demographics and characteristics associated with compliance to statin therapy after switching from branded to generic agents DESIGN: Retrospective cohort study using electronic health records and pharmacy claims data from Sutter Health's ambulatory-care medical network PATIENTS: Managed-care beneficiaries, ≥ 18 years of age, who were switched from branded to generic statins between 1 January 2003 and 31 December 2012 MAIN MEASURES: Compliance was calculated as days of therapy dispensed divided by days from first to last generic prescription fill over 6 months, and was defined as a medication possession ratio ≥ 0.80. We used multivariable logistic regression to assess factors associated with compliance. Adjusted ORs and 95 % CI were generated. KEY RESULTS: We identified 5,156 patients who were switched from branded to generic statins; 73 % of patients were compliant in the 6 months after switching. After statistical adjustment, higher compliance was associated with each 10-year increase in age (OR: 1.13; 95 % CI: 1.07, 1.19; p<0.001), receipt of a generic statin equivalent in potency to the prior branded statin (OR: 1.41; 95 % CI: 1.16, 1.70; p<0.001), and compliance with prior branded statin (OR: 4.68; 95 % CI: 4.07, 5.39; p<0.001). Lower compliance was seen among Hispanic patients compared to non-Hispanic white patients (OR: 0.68; 95 % CI: 0.52, 0.91; p=0.009). Also, a switch to a higher potency generic statin, regardless of prior dose/potency, was negatively associated with compliance after switching (OR: 0.87; 95 % CI: 0.80, 0.94; p=0.001). CONCLUSIONS: The majority of patients switched from branded to generic agents were compliant with therapy in the first 6 months after switching. The potential for non-compliance to generic statin therapy, particularly among younger or Hispanic patients or when dose/potency changes are made, should be considered prior to switching. For these patients, counseling or close monitoring may be required to optimize generic interchange.

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“…Similarly, Eaddy et al59 summarized additional strong evidence that even very low copays of US $3–US $5 per prescription may strongly deter adherence in low-income populations. Most recently, Watanabe et al60 determined that statin adherence among the Veterans Affairs population was higher among those without out-of-pocket expenses; however, adherence dropped in cases where statins required a copayment, but other medications were free, suggesting the importance of the relative cost of medications for those on a multiple-drug regimen. Additionally, results from the MI FREEE Trial61 suggested that eliminating copayments for statins could also improve adherence following a defined cardiac event.…”

Section: Intervention Strategiesmentioning

confidence: 99%

Improving medication adherence in hypercholesterolemia: challenges and solutions

Gatwood

Bailey

2014

VHRM

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Medication nonadherence is a prevalent public health issue that contributes to significant medical costs and detrimental health outcomes. This is especially true in patients with hypercholesterolemia, a condition affecting millions of American adults and one that is associated with increased risk for coronary and cerebrovascular events. Considering the magnitude of outcomes related to this disease, the medical community has placed significant emphasis on addressing the treatment for high cholesterol, and progress has been made in recent years. However, poor adherence to therapy continues to plague health outcomes and more must be understood and done to address suboptimal medication taking. Here we provide an overview of the reasons for poor medication adherence in patients with hypercholesterolemia and describe recent efforts to curb nonadherence. Suggested approaches for improving medication taking in patients with high cholesterol are also provided to guide practitioners, patients, and payers.

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Association of Copayment with Likelihood and Level of Adherence in New Users of Statins: A Retrospective Cohort Study

Abstract: BACKGROUND: Statins remain a fundamental component of pharmacologic therapy for hyperlipidemia. Health benefits of statin therapy are jeopardized when adherence is reduced.

Cited by 20 publications

References 29 publications

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

Predictors of Statin Compliance after Switching from Branded to Generic Agents among Managed-Care Beneficiaries

Improving medication adherence in hypercholesterolemia: challenges and solutions

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