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The purpose of this study was to investigate the relationship between patient out-of-pocket costs and adherence and persistence to hormonal therapy (HT) used in treatment of breast cancer. A retrospective analysis of medical and prescription drug claims for patients with breast cancer (N=6,504) was conducted to estimate the medication possession ratio; adherence; days of persistence; persistence; HT out-of-pocket costs, and total out-of-pocket costs, over 12 months after index HT and over the study period. The multivariate linear regression, logistic regression, and the Cox proportional hazard regression were employed to evaluate the association. The mean (SD) MPR over the 12 months and the study period was 85.6 (23.5) and 89.3 (16.1) percent, respectively. The MPR was positively related to HT out-of-pocket costs and not related to total out-of-pocket costs. Of the study sample, 75.1 percent of the patients were adherent (MPR≥80 percent) to HT over the 12 months period and 82.0 percent were adherent over the study period. The adherence to HT was positively related to HT out-of-pocket costs but not related to total out-of-pocket costs. The mean (SD) days of persistence over the 12 months and the study period were 313.3 (97.8) and 826.8 (583.7) days, respectively. HT out-of-pocket costs and total out-of-pocket costs were inversely related to risk of discontinuation over the 12 months period. The HT out-of-pocket costs and risk of discontinuation were inversely related over the study period. No relationship was observed between total-out-of-pocket costs and risk of discontinuation over the study period. A total of 68.2 percent of the patients were persistent to their therapy for the 12 months and 30.9 percent were persistent (gap of 60 days or less in continuous therapy) for the study period. A positive relationship was observed between HT out-of-pocket and total out-of-pocket costs and persistence during the 12 months period. The study period analyses showed positive relationship between HT out-of-pocket costs and persistence and no relationship between total out-of-pocket costs and persistence. The results show that patient HT adherence and persistence is poor; however, patient HT and total out-of-pocket costs do not have an adverse effect on adherence and persistence.

The purpose of this study was to investigate the relationship between patient out-of-pocket costs and adherence and persistence to hormonal therapy (HT) used in treatment of breast cancer. A retrospective analysis of medical and prescription drug claims for patients with breast cancer (N=6,504) was conducted to estimate the medication possession ratio; adherence; days of persistence; persistence; HT out-of-pocket costs, and total out-of-pocket costs, over 12 months after index HT and over the study period. The multivariate linear regression, logistic regression, and the Cox proportional hazard regression were employed to evaluate the association. The mean (SD) MPR over the 12 months and the study period was 85.6 (23.5) and 89.3 (16.1) percent, respectively. The MPR was positively related to HT out-of-pocket costs and not related to total out-of-pocket costs. Of the study sample, 75.1 percent of the patients were adherent (MPR≥80 percent) to HT over the 12 months period and 82.0 percent were adherent over the study period. The adherence to HT was positively related to HT out-of-pocket costs but not related to total out-of-pocket costs. The mean (SD) days of persistence over the 12 months and the study period were 313.3 (97.8) and 826.8 (583.7) days, respectively. HT out-of-pocket costs and total out-of-pocket costs were inversely related to risk of discontinuation over the 12 months period. The HT out-of-pocket costs and risk of discontinuation were inversely related over the study period. No relationship was observed between total-out-of-pocket costs and risk of discontinuation over the study period. A total of 68.2 percent of the patients were persistent to their therapy for the 12 months and 30.9 percent were persistent (gap of 60 days or less in continuous therapy) for the study period. A positive relationship was observed between HT out-of-pocket and total out-of-pocket costs and persistence during the 12 months period. The study period analyses showed positive relationship between HT out-of-pocket costs and persistence and no relationship between total out-of-pocket costs and persistence. The results show that patient HT adherence and persistence is poor; however, patient HT and total out-of-pocket costs do not have an adverse effect on adherence and persistence.

Statins are commonly used for treating the elevation of lipids in the blood stream, also known as hyperlipidemia. Statins are considered to be an economical and effective way to achieve desirable long-term health outcomes for hyperlipdemic patients, however, ensuring adequate adherence to statin medications is often difficult as hyperlipidemia is an asymptomatic condition and patients sometimes fail to recognize the importance of being adherent to their statin medications. The purpose of this study was to evaluate impact of enrollment under Medicaid and Medicare Part D and patient out-of-pocket costs on patient statin adherence, persistence, and mean number of gap days per claim. A retrospective claims database was used in this study to conduct repeated measures analyses on statin prescription claims from independent community pharmacies in Texas. The pre-period in this study extended from January 1, 2005 to September 30, 2005 (Medicaid period) and the post-period extended from January 1, 2006 to September 30, 2006 (Medicare period). The study population consisted of dual-eligible beneficiaries in Texas who had at least two stain claims in the pre and post-periods each. The final study population comprised of 1734 Texas dual-eligible beneficiaries with 6064 statin claims during the pre-period and 7956 claims during the post-period. Patients had an average of 3.49 statin claims during the pre-period and 4.58 statin claims during the post-period. Patients were dispensed an average of 57.34 days of drug supply per claim during the pre-period and 42.02 days of drug supply per claim during the post-period. The results from this study showed that out-of-pocket costs for patients increased from $0.39 per claim under Medicaid to $13.36 per claim under Medicare Part D. Patient adherence to statins was assessed by calculating medication possession ratio (MPR). The results showed that mean patient MPR increased from 75.71 percent under Medicaid to 79.37 percent under Medicare. Results from generalized estimating equations showed that odds of being adherent (i.e., MPR ≥ 80 percent) to statins increased by 36 percent when patients were covered under Medicare Part D. Linear mixed model analysis showed that MPR increased by 3.66 percent when patients were covered under Medicare Part D compared to Medicaid. Also, patient MPR was found to increase by 0.13 percent when patient out-of-pocket payment increased by $1.00. Patient persistence was calculated by measuring gaps in therapy and patients with a gap of 60 or more days were considered to have discontinued therapy. Patients were found to be persistent to their drug therapy for an average of 151.76 days under Medicaid and 159.75 days under Medicare. Linear mixed model analysis showed that patient persistence increased by 7.99 days when patients were enrolled under Medicare Part D compared to Medicaid. Days of persistence was also found to increase by 0.41 days when patient out-of-pocket costs increased by $1.00. Mean number of gap days per claim during the Medicaid period was 11.91 days and decreased to 8.38 days during the Medicare period. Linear mixed model analysis showed that mean number of gap days per claim decreased by 3.52 days when patients were enrolled under Medicare Part D compared to Medicaid. Mean number of gap days in therapy were found to decrease by 0.10 days when patient out-of-pocket costs increased by $1.00. The results of this study showed that implementation of Medicare Part D resulted in an increase in MPR and persistence and a decrease in mean number of gap days per claim for Texas dual-eligible beneficiaries. The results also suggest that increased out-of-pocket costs under Medicare Part D may not have had a negative impact on statin drug utilization by dual-eligible beneficiaries in Texas.

Statins are commonly used for treating the elevation of lipids in the blood stream, also known as hyperlipidemia. Statins are considered to be an economical and effective way to achieve desirable long-term health outcomes for hyperlipdemic patients, however, ensuring adequate adherence to statin medications is often difficult as hyperlipidemia is an asymptomatic condition and patients sometimes fail to recognize the importance of being adherent to their statin medications. The purpose of this study was to evaluate impact of enrollment under Medicaid and Medicare Part D and patient out-of-pocket costs on patient statin adherence, persistence, and mean number of gap days per claim. A retrospective claims database was used in this study to conduct repeated measures analyses on statin prescription claims from independent community pharmacies in Texas. The pre-period in this study extended from January 1, 2005 to September 30, 2005 (Medicaid period) and the post-period extended from January 1, 2006 to September 30, 2006 (Medicare period). The study population consisted of dual-eligible beneficiaries in Texas who had at least two stain claims in the pre and post-periods each. The final study population comprised of 1734 Texas dual-eligible beneficiaries with 6064 statin claims during the pre-period and 7956 claims during the post-period. Patients had an average of 3.49 statin claims during the pre-period and 4.58 statin claims during the post-period. Patients were dispensed an average of 57.34 days of drug supply per claim during the pre-period and 42.02 days of drug supply per claim during the post-period. The results from this study showed that out-of-pocket costs for patients increased from $0.39 per claim under Medicaid to $13.36 per claim under Medicare Part D. Patient adherence to statins was assessed by calculating medication possession ratio (MPR). The results showed that mean patient MPR increased from 75.71 percent under Medicaid to 79.37 percent under Medicare. Results from generalized estimating equations showed that odds of being adherent (i.e., MPR ≥ 80 percent) to statins increased by 36 percent when patients were covered under Medicare Part D. Linear mixed model analysis showed that MPR increased by 3.66 percent when patients were covered under Medicare Part D compared to Medicaid. Also, patient MPR was found to increase by 0.13 percent when patient out-of-pocket payment increased by $1.00. Patient persistence was calculated by measuring gaps in therapy and patients with a gap of 60 or more days were considered to have discontinued therapy. Patients were found to be persistent to their drug therapy for an average of 151.76 days under Medicaid and 159.75 days under Medicare. Linear mixed model analysis showed that patient persistence increased by 7.99 days when patients were enrolled under Medicare Part D compared to Medicaid. Days of persistence was also found to increase by 0.41 days when patient out-of-pocket costs increased by $1.00. Mean number of gap days per claim during the Medicaid period was 11.91 days and decreased to 8.38 days during the Medicare period. Linear mixed model analysis showed that mean number of gap days per claim decreased by 3.52 days when patients were enrolled under Medicare Part D compared to Medicaid. Mean number of gap days in therapy were found to decrease by 0.10 days when patient out-of-pocket costs increased by $1.00. The results of this study showed that implementation of Medicare Part D resulted in an increase in MPR and persistence and a decrease in mean number of gap days per claim for Texas dual-eligible beneficiaries. The results also suggest that increased out-of-pocket costs under Medicare Part D may not have had a negative impact on statin drug utilization by dual-eligible beneficiaries in Texas.