Abstract P176: Trends in Prescription- and Payment-related Factors That Promote Adherence to Medications Used to Treat Hypertension, 2009-2014
Background: Effective hypertension management often necessitates patients’ adherence to their prescribed blood pressure (BP)-lowering medication regimen. Improving adherence is complex, but can be related to several prescription- and payment-related factors, including: reducing patient out-of-pocket burden with low copayments, increasing generic medication use, prescribing fixed-dose combination pills with more than one BP-lowering medication per pill, limiting the number of pills to take per day, increasing the days’ supply per fill—for example, 90-day vs 30-day allotments, and using mail order pharmacies. These factors are often controlled by prescribers, filling pharmacies, pharmacy benefit managers, and/or patients’ health insurance plans, but not by patients. This study describes patterns and trends in these factors that the literature reports are associated with increased adherence to BP-lowering medication.
Methods and Findings: We use a robust source of United States prescription sales data—IMS Health’s National Prescription Audit (NPA)—to describe BP-lowering medication fill counts and spending for 2009-2014. The NPA includes outpatient prescription information from ~87% of the retail and ~70% of the mail order universe. IMS Health applies a patented projection methodology to the collected data to create the national level estimates within the NPA. We describe patterns and trends in the adherence-promoting factors described above across age groups, payment sources, and medication classes. During 2009-2014, an average of 628 million BP-lowering medication prescriptions was filled annually and encouraging trends 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 trends 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 $28.8B 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).
Conclusions: Annual outpatient BP-lowering medication fill counts and spending were substantial during 2009-2014. We identified both encouraging and possibly undesirable patterns and trends in prescription- and payment-related factors that have been shown to be associated with improved adherence, but are often outside of patients’ control. Continued tracking of these data can be used to identify areas that can be addressed by clinical and policy interventions to improve adherence for medications commonly used to treat hypertension.
Author Disclosures: M.D. Ritchey: None. S. Tsipas: None. F. Loustalot: None. G. Wozniak: None.
- © 2016 by American Heart Association, Inc.