TABLE 2.
Impact of Financial Medication Assistance on Adherence or Persistence
| Author year (journal) | Phase of adherence or persistence | Measure | Impact on adherence or persistence |
|---|---|---|---|
| CARDIOVASCULAR: Program/pharmacy service | |||
| Marrs 200819 (Pharmacotherapy) | Implementation | Mean MPR, % patients with MPR ≥ 75% (over 12 months) | Mean MPR for indigent intervention (participated in Colorado Indigent Care Program) group (0.64, SD = 0.32) was higher than for insured (comparator) group (0.46, SD = 0.24; P = 0.0013). % patients with MPR ≥ 75% for indigent intervention group (48.5%) was higher than for insured group (15%; P < 0.0001). |
| Schoen 201120 (Pharmacotherapy) | Implementation | Self-report (at 6 months) | Patient drug adherence improved from 48.5% at baseline to 72.7% at 6 months (P < 0.001) after intervention (participation in pharmacy service that helps patients find financial medication assistance). |
| CARDIOVASCULAR: Discount card | |||
| Knott 201521 (Health Policy) | Implementation and discontinuation | % who discontinued (no gap defined), % who failed adherence (PDC < 80%) (over 12 months) | 10% of concession (discount card) users versus 17% of general users discontinued statin therapy. 8% of concession users versus 13% of general users failed to adhere to statin therapy. In adjusted analyses, general users had a higher hazard (aHR = 1.63, 95% CI: 1.14-2.33) of discontinuing use and were more likely (aOR = 1.60, 95% CI: 1.04-2.44) likely to fail to adhere to statin therapy compared to concession users. |
| CARDIOVASCULAR: Manufacturer coupon | |||
| Daugherty 201322 (JMCP) | Implementation | Mean MPR, % of patients with MPR > 80% (over 1 year) | Mean MPR was highest for coupon users, slightly lower for patients initiating generic statins, and lowest for noncoupon users (61.1% vs. 60.1% vs. 53.8%; P < 0.001). The % of patients with MPR > 80% was highest for generic users (38.4%), next highest for brand coupon users (36.7%), and lowest for brand non-coupon users (30.4%). |
| Daubresse 201723 (Pharmacotherapy) | Discontinuation | Cumulative probability of terminating statin use (defined as 6-month period without statin use) | Compared to noncoupon users, initial statin coupon users were 6.9% less likely to terminate statin therapy (31.3% vs 39.2%, P < 0.0001) at year 1, and 10.5% less likely to terminate statin therapy (50.6% vs 60.7%; P < 0.0001) at year 4. Subsequent statin coupon users were even less likely to terminate statin therapy at year 1 (8.3%) and 4 (25.9%). Higher levels of coupon use resulted in a lower probability of termination. At 3 years, those who used a coupon on only the first fill were 0.6% more likely to terminate statin therapy than noncoupon users (57.0% vs 56.4%), whereas those who used a coupon for 5+ fills were 27.9% less likely to terminate statin therapy than noncoupon users (27.2% vs 56.4%). |
| CARDIOVASCULAR: Voucher | |||
| Wang 201924 (JAMA) | Persistence | % persistent at one year (cannot have gap ≥ 30 days) through both selfreport and prescription claims data (over 1 year) | Patients in the intervention group (randomized to a hospital that received P2Y12 inhibitor vouchers to provide to their patients) were more likely to report persistence with P2Y12 inhibitor therapy than patients in the usual care group (87.0% vs 83.8%, P < 0.001; observed increase, 3.3% [95% CI: 1.0-5.5]). The intervention significantly increased persistence after adjusting for differences in patient characteristics between groups, with an adjusted odds ratio (OR) of 1.19 (95% CI: 1.02-1.40). Prescription claims-defined persistence rates remained higher among patients in the intervention group than in the usual care group (55.2% vs 46.3%, P < 0.001; adjusted OR, 1.47 [95% CI: 1.29-1.66]). Within the intervention group, rates of medication persistence differed substantially between patients who did and did not use the co-payment voucher, whether measured by patient report (90.0% vs 79.4%, P < 0.001) or pharmacy fill supply (59.8% vs 43.0%, P < 0.001). |
| Fanaroff 202025 (JAMA Cardiology) | Persistence and implementation | % persistent at one year (cannot have gap ≥ 30 days), % with PDC ≥ 80% (over 1 year) | Reduced copayments for P2Y12 inhibitors increased odds of persistence and adherence to other post–MI secondary prevention medications (statins, ß-blockers, and ACEIs/ARBs). Patients discharged from intervention hospitals (received P2Y12 inhibitor vouchers to provide to their patients) were more likely to be persistent in taking statins (46.1% vs 41.9%; aOR = 1.11 [95% CI: 1.00-1.24]) and ß-blockers (47.6% vs 42.5%; aOR = 1.23 [95% CI: 1.10-1.38]). Persistence in taking ACEIs/ARBs was also more likely among patients in the intervention arm than in the usual-care arm, but this was not significant after risk adjustment (43.9% vs 40.5%; aOR = 1.10 [95% CI: 0.97-1.24]). Similar findings for adherence-- Patients discharged from intervention hospitals were more likely to be adherent (PDC ≥ 80%) to statins (51.2% vs 46.9%; aOR = 1.15 [95%CI: 1.03-1.29]) and ß-blockers (52.7% vs 47.9%; aOR = 1.20 [95% CI: 1.07-1.34]). Adherence to ACEIs/ARBs was also more likely among patients in the intervention arm than in the usual-care arm, but this was not significant after risk adjustment (49.2% vs 46.7%; aOR = 1.05 [95% CI: 0.93-1.19]). |
| CANCER: Manufacturer copay card, discount card, or voucher | |||
| Seetasith 201926 (Journal of Medical Economics) | Initiation, persistence, and discontinuation | % who abandoned prescription, time to picking up initial prescription, persistence (gap cannot be > 60 days), % who discontinued (gap > 60 days) (over 1 year) | Patients with copay assistance were less likely to abandon their initial ALKi prescription than patients without copay assistance (4.3% vs 33.3%, P < 0.001). In the adjusted analysis, patients with copay assistance had an 88.2% lower risk of abandoning their first approved claim (RR [95% CI] = 0.12 [0.08-0.18]). Furthermore, for patients who picked up their ALKi prescription (paid claim), the time from the index claim to the first picked up prescription was shorter for patients with copay assistance compared to patients without copay assistance (unadjusted mean [SD] days = 2.6 [28.7] vs 25.7 [115.3], P < 0.001). Patients with copay assistance were more likely to remain on their first ALKi over the 1-year follow-up compared to patients without copay assistance (median days on treatment [95% CI] = 183 [158-215] vs 140 [115-154]; log-rank test P < 0.001). In the adjusted analysis, patients with copay assistance had a 24.3% lower risk of ALKi discontinuation than patients without copay assistance (HR [95% CI] = 0.76 [0.66-0.88]). |
ALKi = anaplastic lymphoma kinase inhibitor; CI = confidence interval; HR = hazard ratio; JAMA = Journal of the American Medical Association; JMCP = Journal of Managed Care & Specialty Pharmacy; MPR = medication possession ratio; PDC = proportion of days covered; RR = risk ratio; SD = standard deviation.