Assessment of drug consumption patterns for Medicare Part D patients.

OBJECTIVES: To assess the time needed to reach the "doughnut hole" (DH) and catastrophic coverage (CC) periods and to identify prescription drug use patterns among patients eligible for the standard Medicare Part D drug benefit. STUDY DESIGN: Retrospective cohort study. METHODS: Data for all prescription drugs dispensed to subjects over age 65 years from November 1, 2006, through February 29, 2008, were obtained from 2 large retail pharmacy chains. Kaplan-Meier estimates of survival curves were used to assess the time to reach the DH and CC thresholds. RESULTS: Of all 2007 Medicare Part D standard benefit patients in our sample, 18.5% reached the DH, but only 11.6% of those patients reached the CC threshold by the end of 2007. Patients who did not reach the DH in 2007 filled an average of 2.13 prescriptions per month. Patients who reached the DH but did not reach the CC threshold filled an average of 4.86 and 4.40 (9.47% decrease; P <.001) prescriptions per month during the initial coverage and DH periods, respectively. Patients who reached the CC threshold filled an average of 7.59, 8.38, and 7.86 prescriptions per month during the initial coverage, DH, and CC periods, respectively. Similar quantitative patterns were observed for patients with various chronic conditions. CONCLUSION: A sizable proportion of standard Medicare Part D drug program beneficiaries reached the DH. Prescription data can help predict the problems beneficiaries enrolled in the standard Medicare Part D drug program might face over time.

Adherence and persistence with fluticasone propionate/salmeterol combination therapy.

BACKGROUND: Pharmacy database medication refill studies provide a panoramic view of medication-taking behavior in patients nationally. OBJECTIVE: To investigate fluticasone propionate/salmeterol combination (FSC) adherence, including the factors associated with refill adherence in a large national pharmacy database. METHODS: Adherence and persistence were documented for 12 months from date of initial FSC prescription in 5504 patients who filled their medication at a nationwide pharmacy chain. RESULTS: On average, patients filled enough medication to cover 22.2% of days. More than half the patients filled a 30-day prescription only once over the 1-year interval. Higher adherence levels were associated with being male, being older than 35 years, having a comorbid disorder, a having a copay of 1.01 dollar to 10 dollars, previous beta2-agonist use, and a prescription for higher-dose FSC. CONCLUSION: This pharmacy database study portrays medication adherence levels to be considerably lower than those reported in most clinical trials, suggests that most adults taking FSC obtain a single fill before abandoning their controller medication, and indicates a need for a reappraisal of current treatment guidelines and educational strategies for both providers and patients. CLINICAL IMPLICATIONS: For many patients, filling of a controller medication is markedly discrepant with practice guidelines. Reappraisal of both the guidelines and strategies to implement them is in order.