Patient access to chronic medications during the Covid-19 pandemic: Evidence from a comprehensive dataset of US insurance claims

Abstract

Patient access and adherence to chronic medications is critical. In this work, we evaluate whether disruptions related to Covid-19 have affected new and existing patients’ access to pharmacological therapies without interruption. We do so by performing a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients from May, 2019 through August, 2020 (about 93% of prescriptions dispensed within those months). 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. Findings indicate that more prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in monthly dispensing. Compared to the pre-Covid era, a patient’s likelihood of discontinuing some medications increased after the spread of Covid: norgestrel-ethinyl estradiol (hormonal contraceptive) discontinuation increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD stimulant treatment) discontinuation increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI antidepressant) discontinuation increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) discontinuation increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in new patients accessing these latter two therapies. 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 than in previous months. Further, fewer than normal new patients started taking medications that may be vital to their care. 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.

COVID-19: Factors Associated with Psychol­­­ogical Distress, Fear, and Coping Strategies among Community Members Across 17 Countries

“…[21] Medication adherence for this group of patients could have been challenging without caregiving provision. [22] Accessibility to the health care system was more di cult because most healthcare workers were overloaded with COVID-19 infected patients and the related tasks, therefore, managing chronic diseases was not a priority. In addition, lockdown policies impacted transportation and public facilities were closed in many instances.…”

“…Descriptive statistics, including frequencies and percentages, were generated for categorical variables; means and standard deviations (SD) were generated for continuous variables. Psychological distress (based on the K-10 scoring) was categorised into low (score 10-15) and moderate to very high (score 16-50), fear of COVID-19 (based on the FCV-19S scoring) was categorised into low (score 7-21) and high (score [22][23][24][25][26][27][28][29][30][31][32][33][34][35], and coping (based on the BRCS scoring) was categorised into low (score 4-13) and medium to high (score 14-20).…”

Predict Health Care Accessibility for Texas Medicaid Gap

“…Current studies highlighted the policy adjustment from the qualitative analysis [25][26][27][28] except for Spencer et al (2019). Despite the Medicaid Gap population in North Carolina for health access was conducted in Statistical inference, counter-comparative multi-variated indexes were not involved [29]. In addition, potential risks of chronic diseases were not estimated in the research.…”

Income gradient of pharmaceutical panic buying at the outbreak of the COVID‐19 pandemic

“…Clement et al. ( 2021 ) document a surge in the demand for prescription drugs in March 2020 in the United States and also prove that the likelihood of discontinuing some medications increased and the number of new patients decreased after the spread of COVID‐19. Our main contributions to this evolving literature are twofold.…”