Racial Disparities and the Impact of Access Restrictions to Apixaban in Part D
Author(s)
Prachi Bhatt, PharmD, MPH, Gabriela Dieguez, FSA, MAAA.
Milliman, Inc., New York, NY, USA.
Milliman, Inc., New York, NY, USA.
Presentation Documents
OBJECTIVES: Utilization management and formulary restrictions may lead to therapy abandonment and nonmedical switching, although their potential impact on beneficiaries of different races is not well understood. This analysis quantifies the impact of apixaban access restrictions on treatment rates and script counts, by race, among Part D beneficiaries.
METHODS: Using 2024 CMS 100% Part D files, we examined the impact of changes in formulary tier or step edits (SEs) on apixaban use among beneficiaries not eligible for low-income subsidies, grouped by race. We summarized the impacts of changing from preferred brand status (Tier 3) to non-preferred (Tier 4) and of introducing SEs on the number of patients treated (≥1 apixaban scripts)/1,000 beneficiaries and 30-day script counts/patient, regardless of indication.
RESULTS: White beneficiaries had higher apixaban utilization than Black, Hispanic, and Asian beneficiaries (83.5 vs 35.6-58.6/1,000). Changing apixaban from Tier 3 to Tier 4 resulted in 61.3 fewer patients/1,000 on apixaban (76.8/1,000 on Tier 3 vs 15.5/1,000 on Tier 4) and 1.2 fewer 30-day scripts/patient (from 7.6 to 6.4, respectively). Reductions in apixaban treatment rates following Tier 4 placement were observed across races, although white beneficiaries had the greatest reduction (80%, vs. 63%-76% for Black, Hispanic, and Asian beneficiaries). SE implementation resulted in 61 fewer patients/1,000 on apixaban (75.1/1,000 without SEs vs 14.1/1,000 with SEs) and 2.2 fewer 30-day scripts/patient (from 7.6 to 5.4, respectively). Reductions in apixaban treatment rates were relatively consistent across races (83%-87%).
CONCLUSIONS: Barriers to access via non-preferred tier placement or step edits resulted in substantially lower treatment rates and reduced script counts across all races. White beneficiaries had both higher treatment rates and greater impact following non-preferred tier placement, suggesting higher benefit awareness and more optimal Part D plan selection to mitigate out-of-pocket costs.
METHODS: Using 2024 CMS 100% Part D files, we examined the impact of changes in formulary tier or step edits (SEs) on apixaban use among beneficiaries not eligible for low-income subsidies, grouped by race. We summarized the impacts of changing from preferred brand status (Tier 3) to non-preferred (Tier 4) and of introducing SEs on the number of patients treated (≥1 apixaban scripts)/1,000 beneficiaries and 30-day script counts/patient, regardless of indication.
RESULTS: White beneficiaries had higher apixaban utilization than Black, Hispanic, and Asian beneficiaries (83.5 vs 35.6-58.6/1,000). Changing apixaban from Tier 3 to Tier 4 resulted in 61.3 fewer patients/1,000 on apixaban (76.8/1,000 on Tier 3 vs 15.5/1,000 on Tier 4) and 1.2 fewer 30-day scripts/patient (from 7.6 to 6.4, respectively). Reductions in apixaban treatment rates following Tier 4 placement were observed across races, although white beneficiaries had the greatest reduction (80%, vs. 63%-76% for Black, Hispanic, and Asian beneficiaries). SE implementation resulted in 61 fewer patients/1,000 on apixaban (75.1/1,000 without SEs vs 14.1/1,000 with SEs) and 2.2 fewer 30-day scripts/patient (from 7.6 to 5.4, respectively). Reductions in apixaban treatment rates were relatively consistent across races (83%-87%).
CONCLUSIONS: Barriers to access via non-preferred tier placement or step edits resulted in substantially lower treatment rates and reduced script counts across all races. White beneficiaries had both higher treatment rates and greater impact following non-preferred tier placement, suggesting higher benefit awareness and more optimal Part D plan selection to mitigate out-of-pocket costs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR110
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Pricing Policy & Schemes, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)