Impact of Increased Patients' Out-of-Pocket Costs on Oral Anticoagulant Discontinuation among Medicare Beneficiaries with Atrial Fibrillation Treated with Apixaban
Author(s)
Dominick Latremouille-Viau, MSc1, Aolin Wang, PhD2, Dong Cheng, PhD3, Serina Deeba, MPH4, Radhika Gomez, PharmD3, Anandkumar Dubey, MBA, PhD3, Abigail Zion, BS5, Grace Chen, MPH5, Elisabeth Vodicka, MHA, PhD4.
1Analysis Group, Inc., Montreal, QC, Canada, 2Analysis Group, Inc., New York, NY, USA, 3Bristol Myers Squibb, Lawrenceville, NJ, USA, 4Pfizer, Inc., New York, NY, USA, 5Analysis Group, Inc., Boston, MA, USA.
1Analysis Group, Inc., Montreal, QC, Canada, 2Analysis Group, Inc., New York, NY, USA, 3Bristol Myers Squibb, Lawrenceville, NJ, USA, 4Pfizer, Inc., New York, NY, USA, 5Analysis Group, Inc., Boston, MA, USA.
OBJECTIVES: To describe patients’ out-of-pocket costs (OOPC) for apixaban before and after a formulary tier increase and association between increased OOPC and treatment discontinuation among Medicare beneficiaries with atrial fibrillation (AF).
METHODS: This retrospective cohort study using Medicare fee-for-service (FFS) claims database (01/01/2012-12/31/2019) included patients with AF who initiated apixaban between 01/01/2013-12/31/2016, with prescription drug plans that increased apixaban's formulary tier in 2017. Patients had continuous Medicare Parts A/B/D enrollment for ≥12 months before apixaban initiation through 12/31/2017 (with same Part D plan) and uninterrupted apixaban use through 12/31/2016. Treatment discontinuation was defined as apixaban treatment gap of >30 consecutive days without switching to another oral anticoagulant (OAC). Association between increased OOPC for apixaban after higher tier placement and treatment discontinuation was assessed using logistic regression.
RESULTS: Of the 1,761 patients treated with apixaban in 2016 (mean age 78.1 years, 54.0% male, 94.5% White, 34.4% from the South), 30.1% discontinued treatment in 2017. Most (97.5%) had tier 3 formulary coverage for apixaban in 2016 that increased to tier 4, newly requiring prior authorization in 2017. In 2016 and 2017, respectively, mean (median; interquartile range) monthly OOPC for apixaban was $75.09 ($66.86; $44.20-$104.29) and $137.11 ($166.50; $67.80-$195.69, representing a monthly mean OOPC increase of $61.04 ($58.33; $3.56-$117.82). Among patients facing increased OOPC (N=1,241 [70.5%]), those with the highest increase (4th quartile ∆>$135.63) had 1.54 times the odds of discontinuing treatment in 2017 compared to those with the lowest increase (1st quartile ∆>$0-$39.67; odds ratio [OR]: 1.54, p<0.01). The odds of treatment discontinuation were 1.03 times higher for each additional $10 OOPC increment (OR: 1.03, p<0.01).
CONCLUSIONS: Following formulary tier increase among Medicare beneficiaries with AF, OOPC for 30-day apixaban supply rose by $61 on average, and almost one-third subsequently discontinued treatment. Patients with increased OOPC were associated with a higher probability of OAC discontinuation.
METHODS: This retrospective cohort study using Medicare fee-for-service (FFS) claims database (01/01/2012-12/31/2019) included patients with AF who initiated apixaban between 01/01/2013-12/31/2016, with prescription drug plans that increased apixaban's formulary tier in 2017. Patients had continuous Medicare Parts A/B/D enrollment for ≥12 months before apixaban initiation through 12/31/2017 (with same Part D plan) and uninterrupted apixaban use through 12/31/2016. Treatment discontinuation was defined as apixaban treatment gap of >30 consecutive days without switching to another oral anticoagulant (OAC). Association between increased OOPC for apixaban after higher tier placement and treatment discontinuation was assessed using logistic regression.
RESULTS: Of the 1,761 patients treated with apixaban in 2016 (mean age 78.1 years, 54.0% male, 94.5% White, 34.4% from the South), 30.1% discontinued treatment in 2017. Most (97.5%) had tier 3 formulary coverage for apixaban in 2016 that increased to tier 4, newly requiring prior authorization in 2017. In 2016 and 2017, respectively, mean (median; interquartile range) monthly OOPC for apixaban was $75.09 ($66.86; $44.20-$104.29) and $137.11 ($166.50; $67.80-$195.69, representing a monthly mean OOPC increase of $61.04 ($58.33; $3.56-$117.82). Among patients facing increased OOPC (N=1,241 [70.5%]), those with the highest increase (4th quartile ∆>$135.63) had 1.54 times the odds of discontinuing treatment in 2017 compared to those with the lowest increase (1st quartile ∆>$0-$39.67; odds ratio [OR]: 1.54, p<0.01). The odds of treatment discontinuation were 1.03 times higher for each additional $10 OOPC increment (OR: 1.03, p<0.01).
CONCLUSIONS: Following formulary tier increase among Medicare beneficiaries with AF, OOPC for 30-day apixaban supply rose by $61 on average, and almost one-third subsequently discontinued treatment. Patients with increased OOPC were associated with a higher probability of OAC discontinuation.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR109
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Pricing Policy & Schemes, Reimbursement & Access Policy
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)