Cardiovascular Drugs and Therapy

, Volume 28, Issue 1, pp 99–109

Patient Co-payment and Adherence to Statins: A Review and Case Studies

REVIEW ARTICLE

Abstract

Purpose

This study aims to review the international literature about whether there is an association between co-payment and statin adherence, and to present case studies to illustrate the impact of a reduction in patient co-payment associated with generic drugs on improving therapy adherence.

Methods

Studies that examined the impact of patient co-payment on statin adherence were identified in PubMed, Cochrane Central Register of Controlled Trials and EconLit up to January 2013. A standardized data extraction form was completed for each included study, collecting information about country, sample, setting, adherence measure, design, results about the impact of co-payment on statin adherence, and methodological quality. Two cases from the outpatient clinic of one the authors (PRS) were added.

Results

The literature supported a statistically significant negative association between co-payment and statin adherence. This association appeared to be influenced by the absolute level of co-payments, the size of the co-payment change, whether co-payment increases or decreases, the time horizon over which the impact of a co-payment change is examined, the type of drug for which co-payment changes (e.g. generic or branded drug), the availability of alternative drugs and switching behaviour. Two case studies illustrated that cost issues are important to patients and that patient adherence to statin therapy improved following a switch to generic statins.

Conclusions

Current studies have demonstrated that statin adherence is influenced by co-payment and a range of patient, physician and pharmacy characteristics. Nevertheless, the power of these models to explain the variation in adherence remains limited.

Keywords

Adherence Case study Co-payment Review Statin 

References

  1. 1.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–97.PubMedCrossRefGoogle Scholar
  2. 2.
    Eaddy MT, Cook CL, O’Day K, Burch SP, Cantrell CR. How patient cost-sharing trends affect adherence and outcomes: a literature review. P T. 2012;37:45–55.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Sinnott SJ, Buckley C, O’Riordan D, Bradley C, Whelton H. The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; a systematic review and meta-analysis. Plos One. 2013;8:e64914.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Austvoll-Dahlgren A, Aaserud M, Vist G, Ramsay C, Oxman AD, Sturm H, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Database Syst Rev. 2008:CD007017.Google Scholar
  5. 5.
    Gibson TB, Ozminkowski RJ, Goetzel RZ. The effects of prescription drug cost sharing: a review of the evidence. Am J Manage Care. 2005;11:730–40.Google Scholar
  6. 6.
    Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA. 2007;298:61–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Sturm H, Austvoll-Dahlgren A, Aaserud M, Oxman AD, Ramsay C, Vernby A, et al. Pharmaceutical policies: effects of financial incentives for prescribers. Cochrane Database Syst Rev. 2007:CD006731.Google Scholar
  8. 8.
    Choudhry NK, Avorn J, Glynn RJ, Antman EM, Schneeweiss S, Toscano M, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med. 2011;365:2088–97.PubMedCrossRefGoogle Scholar
  9. 9.
    Hsu J, Price M, Huang J, Brand R, Fung V, Hui R, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006;354:2349–59.PubMedCrossRefGoogle Scholar
  10. 10.
    Choudhry NK, Fischer MA, Avorn JL, Lee JL, Schneeweiss S, Solomon DH, et al. The impact of reducing cardiovascular medication copayments on health spending and resource utilization. J Am Coll Cardiol. 2012;60:1817–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6:208–15.PubMedCrossRefGoogle Scholar
  12. 12.
    Peterson AM, McGhan WF. Pharmacoeconomic impact of non-compliance with statins. Pharmacoeconomics. 2005;23:13–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285:421–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med. 2013;126:357.PubMedCrossRefGoogle Scholar
  15. 15.
    Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Cochrane Collaboration 2011. Available from: URL: www.cochrane-handbook.org.
  16. 16.
    GRADE Working Group. Grading of recommendations assessment, development and evaluation. GRADE Working Group 2013. Available from: URL: http://www.gradeworkinggroup.org/.
  17. 17.
    Schneeweiss S, Patrick AR, Maclure M, Dormuth CR, Glynn RJ. Adherence to statin therapy under drug cost sharing in patients with and without acute myocardial infarction: a population-based natural experiment. Circulation. 2007;115:2128–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Coombs JH, Cornish L, Hiller P, Smith DG. Compliance and refill pattern behavior with HMG-CoA reductase inhibitors after acute myocardial infarction. Manag Care Interface. 2002;15:54–8. 60.PubMedGoogle Scholar
  19. 19.
    Choudhry NK, Fischer MA, Avorn J, Schneeweiss S, Solomon DH, Berman C, et al. At Pitney Bowes, value-based insurance design cut copayments and increased drug adherence. Health Aff (Millwood). 2010;29:1995–2001.CrossRefGoogle Scholar
  20. 20.
    Schultz JS, O’Donnell JC, McDonough KL, Sasane R, Meyer J. Determinants of compliance with statin therapy and low-density lipoprotein cholesterol goal attainment in a managed care population. Am J Manage Care. 2005;11:306–12.Google Scholar
  21. 21.
    Ye X, Gross CR, Schommer J, Cline R, St Peter WL. Association between copayment and adherence to statin treatment initiated after coronary heart disease hospitalization: a longitudinal, retrospective, cohort study. Clin Ther. 2007;29:2748–57.PubMedCrossRefGoogle Scholar
  22. 22.
    Ellis JJ, Erickson SR, Stevenson JG, Bernstein SJ, Stiles RA, Fendrick AM. Suboptimal statin adherence and discontinuation in primary and secondary prevention populations. J Gen Intern Med. 2004;19:638–45.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Gibson TB, Mark TL, McGuigan KA, Axelsen K, Wang S. The effects of prescription drug copayments on statin adherence. Am J Manage Care. 2006;12:509–17.Google Scholar
  24. 24.
    Gibson TB, Mark TL, Axelsen K, Baser O, Rublee DA, McGuigan KA. Impact of statin copayments on adherence and medical care utilization and expenditures. Am J Manage Care. 2006;12(Spec no):SP11–9.Google Scholar
  25. 25.
    Ray WA. Evaluating medication effects outside of clinical trials: new-user designs. Am J Epidemiol. 2003;158:915–20.PubMedCrossRefGoogle Scholar
  26. 26.
    Chernew ME, Shah MR, Wegh A, Rosenberg SN, Juster IA, Rosen AB, et al. Impact of decreasing copayments on medication adherence within a disease management environment. Health Aff (Millwood). 2008;27:103–12.CrossRefGoogle Scholar
  27. 27.
    Frank MB, Fendrick AM, He Y, Zbrozek A, Holtz N, Leung S, et al. The effect of a large regional health plan’s value-based insurance design program on statin use. Med Care. 2012;50:934–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Goldman DP, Joyce GF, Karaca-Mandic P. Varying pharmacy benefits with clinical status: the case of cholesterol-lowering therapy. Am J Manage Care. 2006;12:21–8.Google Scholar
  29. 29.
    Landsman PB, Yu W, Liu X, Teutsch SM, Berger ML. Impact of 3-tier pharmacy benefit design and increased consumer cost-sharing on drug utilization. Am J Manage Care. 2005;11:621–8.Google Scholar
  30. 30.
    Maciejewski ML, Farley JF, Parker J, Wansink D. Copayment reductions generate greater medication adherence in targeted patients. Health Aff (Millwood). 2010;29:2002–8.CrossRefGoogle Scholar
  31. 31.
    Sedjo RL, Cox ER. Lowering copayments: impact of simvastatin patent expiration on patient adherence. Am J Manage Care. 2008;14:813–8.Google Scholar
  32. 32.
    Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11:44–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Peterson AM, Nau DP, Cramer JA, Benner J, Gwadry-Sridhar F, Nichol M. A checklist for medication compliance and persistence studies using retrospective databases. Value Health. 2007;10:3–12.PubMedCrossRefGoogle Scholar
  34. 34.
    Chan DC, Shrank WH, Cutler D, Jan S, Fischer MA, Liu J, et al. Patient, physician, and payment predictors of statin adherence. Med Care. 2010;48:196–202.PubMedCrossRefGoogle Scholar
  35. 35.
    Doshi JA, Zhu J, Lee BY, Kimmel SE, Volpp KG. Impact of a prescription copayment increase on lipid-lowering medication adherence in veterans. Circulation. 2009;119:390–7.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Karaca-Mandic P, Swenson T, Abraham JM, Kane RL. Association of medicare part D medication out-of-pocket costs with utilization of statin medications. Health Serv Res. 2013;48(4):1311–33.Google Scholar
  37. 37.
    Maciejewski ML, Bryson CL, Perkins M, Blough DK, Cunningham FE, Fortney JC, et al. Increasing copayments and adherence to diabetes, hypertension, and hyperlipidemic medications. Am J Manage Care. 2010;16:e20–34.Google Scholar
  38. 38.
    Pedan A, Varasteh L, Schneeweiss S. Analysis of factors associated with statin adherence in a hierarchical model considering physician, pharmacy, patient, and prescription characteristics. J Manag Care Pharm. 2007;13:487–96.PubMedGoogle Scholar
  39. 39.
    Goldman DP, Joyce GF, Escarce JJ, Pace JE, Solomon MD, Laouri M, et al. Pharmacy benefits and the use of drugs by the chronically ill. JAMA. 2004;291:2344–50.PubMedCrossRefGoogle Scholar
  40. 40.
    Lemstra M, Blackburn D, Crawley A, Fung R. Proportion and risk indicators of nonadherence to statin therapy: a meta-analysis. Can J Cardiol. 2012;28:574–80.PubMedCrossRefGoogle Scholar
  41. 41.
    Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother. 2010;44:1410–21.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Choudhry NK, Avorn J, Antman EM, Schneeweiss S, Shrank WH. Should patients receive secondary prevention medications for free after a myocardial infarction? An economic analysis. Health Aff (Millwood). 2007;26:186–94.CrossRefGoogle Scholar
  43. 43.
    Choudhry NK, Patrick AR, Antman EM, Avorn J, Shrank WH. Cost-effectiveness of providing full drug coverage to increase medication adherence in post-myocardial infarction Medicare beneficiaries. Circulation. 2008;117:1261–8.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    van Dalem J, Krass I, Aslani P. Interventions promoting adherence to cardiovascular medicines. Int J Clin Pharm. 2012;34:295–311.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Pharmaceutical and Pharmacological SciencesKU LeuvenLeuvenBelgium
  2. 2.Department of Cardiovascular MedicineUniversity Hospitals LeuvenLeuvenBelgium

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