Use of Pharmacy Sales Data to Assess Changes in Prescription- and Payment-Related Factors that Promote Adherence to Medications Commonly Used to Treat Hypertension, 2009 and 2014

Abstract

BackgroundEffective hypertension management often necessitates patients’ adherence to the blood pressure (BP)-lowering medication regimen they are prescribed. Patients’ adherence to that regimen can be affected by prescription- and payment-related factors that are typically controlled by prescribers, filling pharmacies, pharmacy benefit managers, and/or patients’ health insurance plans. This study describes patterns and changes from 2009 to 2014 in factors that the literature reports are associated with increased adherence to BP-lowering medication.Methods and FindingsWe use a robust source of United States prescription sales data—IMS Health’s National Prescription Audit—to describe BP-lowering medication fill counts and spending in 2009 compared with 2014. Moreover, we describe patterns and changes in adherence-promoting factors across age groups, payment sources, and medication classes. From 2009 to 2014, the BP-lowering medication prescription fill count increased from 613.7 million to 653.0 million. Encouraging changes in adherence-promoting factors included: the share of generic fills increased from 82.5% to 95.0%; average days’ supply per fill increased from 45.9 to 51.8 days; and average total (patient contribution) spending per years’ supply decreased from $359 ($54) to $311 ($37). Possibly undesirable changes included: the percentage of fills for fixed-dose combinations decreased from 17.1% to 14.2% and acquired via mail order decreased from 10.7% to 8.2%. In 2014: 653.0 million fills occurred accounting for $28.81B in spending; adults aged 45–64 years had the highest percentage of fixed-dose combinations fills (16.9%); and fills with Medicaid as the payment source had the lowest average patient spending per fill ($1.19).ConclusionsWe identified both encouraging and possibly undesirable patterns and changes from 2009 to 2014 in factors that promote adherence to BP-lowering medications during this period. Continued tracking of these metrics using pharmacy sales data can help identify areas that can be addressed by clinical and policy interventions to improve adherence for medications commonly used to treat hypertension.

Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use Among Adults Aged ≥18 Years — United States, 2011–2015

“…A previous study found that hypertension medication prescriptions provided during U.S. physician office visits increased from 69.2% to 78.8% from 2003–2004 to 2009–2010 ( 5 ). U.S. prescription sales data also indicated that prescription fill counts for antihypertensive medication increased from 2009 to 2014 ( 6 ). Data from the National Health and Nutrition Examination Survey indicated that antihypertensive medication use increased from 63.5% (2001–2002) to 77.3% (2009–2010) ( 7 ).…”

State and Regional Variation in Prescription- and Payment-Related Promoters of Adherence to Blood Pressure Medication

“…Improving the affordability of medications by addressing payment-related adherence factors is another opportunity to increase adherence among patients with hypertension (11)(12)(13). Minimal variation was observed in generic medication concentrations across markets, suggesting that access to these lower cost therapies is widespread.…”

“…Lower out-ofpocket spending was more concentrated in public insurance markets, especially Medicaid, while higher copayments and out-ofpocket costs were observed among patients with commercial plans, especially in the South where our analysis identified the highest rates of out-of-pocket spending per therapy year among the commercially insured in this region. Higher costs may impose a barrier to adherence, particularly for low-income patient populations for whom even low costs can be prohibitive (13), especially when these costs are compounded by complex medication regimens potentially needed for multiple comorbidities (30). These cost-related factors may be a reason for the low adherence rates seen in the South (31) and, consequently, may play a role in the region's lower BP control rates and higher rates of cardiovascular disease morbidity and mortality than in other census regions (32).…”

“…Prescription-related factors are prescribing fixed-dose combination medications to reduce total pill consumption (8), using mail order prescriptions to address barriers in access to retail pharmacies and to make acquiring prescriptions more convenient for patients (9), and increasing the days' supply per fill to decrease pharmacy visits (10). Payment-related factors to reduce financial barriers are prescribing low-price generic formulations (11), using medications with lower or no patient copayments (12), and minimizing overall out-of-pocket costs for patients (13).…”

National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults—United States, 2011–2015

“…1 NPA data have previously been used to provide outpatient dispensed prescription estimates on a national level. 26 The NPA sample included pharmacy records from nearly 48,000 retail pharmacies across the USA, representing approximately 80% of all retail prescription activity from independent and chain pharmacies and pharmacies in food and mass merchandise stores, and an additional 1800 pharmacies serving long-term care facilities. 1…”