OBJECTIVES: Anticoagulants are critical in managing atrial fibrillation (AFib) patients, and health plan claims data are used to assess patient utilization and outcomes associated with anticoagulant use. Prescription claims (Rx) may be missing in these data as patients use discount cards, cash, Medicaid or Medicare PartD which are not captured by the health plan. This study identifies missing anticoagulant Rx information in AFib patients and augments the data with pharmacy point-of-sale (POS) data to generate more complete Rx information.

METHODS: A retrospective cohort study using the IQVIA PharMetrics® Plus database identified patients with a medical claim with ≥1 AFib diagnosis and continuous medical and pharmacy eligibility (CE) between 1/1/19-12/31/20. Patients were linked to the IQVIA Longitudinal Access and Adjudication Database (LAAD), a POS database. All prescriptions for coumarin anticoagulants (CA) or thrombin inhibitors (TI) were identified. The data from PharMetrics Plus and LAAD was merged and de-duplicated to identify claims that were missing in the PharMetrics Plus database.

RESULTS: Overall, 186,025 patients with AFib and 2-year CE were linkable to LAAD. Of these, 26,888 (14.5%) had ≥1 Rx for CA and 91,759 (49.3%) had ≥1 Rx for TI in PharMetrics Plus. The merged dataset found 1,715 (6.4%) and 4,400 (4.8%) additional patients CA and TI utilization, respectively. Additionally, 40.3% of CA and 38.7% of TI patients were missing ≥1 Rx during the study period, and overall, 14.3% of the CA and 10.3% of the TI Rx volume was missing. The pay status of the missing claims included 7.2% for cash/discount card, 38.1% for Medicare/Medicaid and 54.6% for other commercial payers.

CONCLUSIONS: Appending POS Rx data to health plan claims data provides a more complete picture of the use of anticoagulants in the AFib population. This technique may be useful across many acute and chronic conditions.