PMID- 30156451
OWN - NLM
STAT- MEDLINE
DCOM- 20181211
LR  - 20230805
IS  - 2376-1032 (Electronic)
IS  - 2376-0540 (Print)
IS  - 2376-0540 (Linking)
VI  - 24
IP  - 9
DP  - 2018 Sep
TI  - Novel Type 2 Diabetes Medication Access and Effect of Patient Cost Sharing.
PG  - 847-855
LID - 10.18553/jmcp.2018.24.9.847 [doi]
AB  - BACKGROUND: Although drug formulary restrictions may reduce use of prescription 
      medication and pharmacy costs, the effect of patient cost sharing on medication 
      adherence and health care utilization and cost is unclear. OBJECTIVE: To evaluate 
      the relationship between patient cost sharing for novel type 2 diabetes mellitus 
      (T2DM) medications and medication adherence, persistence, and health care 
      utilization and cost. METHODS: This retrospective study used medical and pharmacy 
      claims linked to pharmacy benefit plan design data. Patients with T2DM were 
      identified via ICD-9-CM codes (medical claims), outpatient prescription fills 
      (pharmacy claims), and pharmacy benefit design information. Patients with T2DM 
      treated with novel T2DM medications (DPP4 or GLP-1) were enrolled in plans with 
      fixed or coinsurance medication copayment structures and followed for 12-48 
      months. Endpoints included medication persistence and adherence and total 
      all-cause health care cost. Multivariable regression analysis estimated the 
      effect of benefit design parameters, adjusting for baseline patient 
      characteristics. RESULTS: The integrated database included 36,475 patients with 
      T2DM. The majority (83.1%) had fixed copayment plans, and 3-tier plans were 
      common (93.1%). Higher third-tier copayment was associated with poorer medication 
      adherence and persistence but not total health care cost during follow-up. A $10 
      higher third-tier copayment was associated with 11% greater risk of novel T2DM 
      medication discontinuation and 3% lower adherence. A comparison of patients with 
      fixed versus coinsurance plans found that fixed plans were associated with higher 
      adjusted persistence and total all-cause health care costs. CONCLUSIONS: Higher 
      medication copayment amounts were associated with lower patient medication 
      adherence and persistence in T2DM but not total health care costs, as health plan 
      costs decreased while patient out-of-pocket costs increased. We observed higher 
      total all-cause health care costs among T2DM patients with a fixed copay (vs. 
      coinsurance) pharmacy benefit. Additional research incorporating plan design 
      information is needed to further examine this finding. DISCLOSURES: This study 
      was funded by Janssen Scientific Affairs, which was involved in study design, 
      interpretation of data, editing manuscript content, and had final approval of the 
      manuscript before submission. Lopez and Bookhart are employed by Janssen 
      Scientific Affairs. At the time of this study, Henk was employed by Optum HEOR, 
      which was contracted by Janssen to conduct this study. Portions of this study 
      were presented at the 21st Annual International Meeting, ISPOR; May 21-25, 2016; 
      in Washington, DC.
FAU - Henk, Henry J
AU  - Henk HJ
AD  - 1 Optum, Eden Prairie, Minnesota.
FAU - Lopez, Janice M S
AU  - Lopez JMS
AD  - 2 Janssen Scientific Affairs, Titusville, New Jersey.
FAU - Bookhart, Brahim K
AU  - Bookhart BK
AD  - 3 Janssen Scientific Affairs, Raritan, New Jersey.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - J Manag Care Spec Pharm
JT  - Journal of managed care & specialty pharmacy
JID - 101644425
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - Cost Sharing/*economics/trends
MH  - Diabetes Mellitus, Type 2/*drug therapy/*economics/epidemiology
MH  - Female
MH  - Health Services Accessibility/*economics/trends
MH  - Humans
MH  - Hypoglycemic Agents/*economics/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
PMC - PMC10397984
COIS- This study was funded by Janssen Scientific Affairs, which was involved in study 
      design, interpretation of data, editing manuscript content, and had final 
      approval of the manuscript before submission. Lopez and Bookhart are employed by 
      Janssen Scientific Affairs. At the time of this study, Henk was employed by Optum 
      HEOR, which was contracted by Janssen to conduct this study. Portions of this 
      study were presented at the 21st Annual International Meeting, ISPOR; May 21-25, 
      2016; in Washington, DC.
EDAT- 2018/08/30 06:00
MHDA- 2018/12/12 06:00
PMCR- 2018/09/01
CRDT- 2018/08/30 06:00
PHST- 2018/08/30 06:00 [entrez]
PHST- 2018/08/30 06:00 [pubmed]
PHST- 2018/12/12 06:00 [medline]
PHST- 2018/09/01 00:00 [pmc-release]
AID - 10.18553/jmcp.2018.24.9.847 [doi]
PST - ppublish
SO  - J Manag Care Spec Pharm. 2018 Sep;24(9):847-855. doi: 
      10.18553/jmcp.2018.24.9.847.