Data were extracted from electronic health record (EHR) and pharmacy claims databases. We performed a single-center, retrospective analysis of specialty oncology prescriptions electronically prescribed between January and December 2018. The objectives of this study were to compute the rates of and reasons for PMN in patients prescribed oral oncology medications at an integrated health-system specialty pharmacy (IHSSP). Addressing PMN is essential to ensuring patient access and uptake and realizing benefits of these therapies. Limited research has evaluated rates and reasons for PMN within a specialty oncology population. Patients prescribed specialty oncology medications face logistical and financial challenges to medication procurement, leading to primary medication nonadherence (PMN). Our results indicate the importance of considering social risk factors in the evaluation of barriers to antiplatelet adherence following PCI. In a claims-based analysis, we determined that lower income is associated with decreased likelihood of adherence to antiplatelet agents following PCI. Individuals with annual income <$40,000 had 1.5-fold higher odds of non-adherence (95% CI, 1.40–1.56) compared to those with income ≥$100,000 after multivariable adjustment. We observed graded, decreased antiplatelet adherence across income categories: rates of PDC≥80% decreased with successively lower income. Our dataset included 90,163 individuals (age 69.0 ± 10.9 years, 33.1% women, 25.1% non-White race) who underwent PCI. We related annual household income, categorized as <$40,000 $40–49,999 $50–59,999 $60–74,999 $75–99,999 and ≥$100 K, to proportion of days covered (PDC) in multivariable-adjusted regression models. We collected data on age, sex, race, ethnicity, educational attainment, and covariates (prevalent coronary disease, medications, healthcare visits, insurance type, copay, antiplatelet medications, and Elixhauser Comorbidity Index conditions). We identified individuals presenting with PCI in an administrative claims database of commercially insured and Medicare Advantage beneficiaries from 2017 to 2019. Social risk factors like household income modify how patients access and adhere to essential pharmacologic therapies such as antiplatelet agents. Adherence to these medications is essential to reduce risk of stent thrombosis and recurrent ischemic events. Treatment with 6–12 months of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) is a Class I recommendation. To investigate the relation of annual household income to antiplatelet adherence following PCI. Second, interventions aimed at addressing economic barriers to medication filling may help in addressing the income-based disparities in adherence that we observed. First, attention to formulary status and medication costs may promote adherence, although this will need to be tested further. This study adds to other recent analyses that demonstrate how common nonadherence is, but goes further by identifying factors that may be amenable to interventions to improve medication adherence. Most important, our present study identifies Conclusions Our study adds to recent analyses documenting considerable nonadherence to e-prescribed medication.12, 13, 14, 15, 16 This larger and more nationally representative study confirms the high rates of nonadherence seen in other settings, finding that 24% of new e-prescriptions are not filled within 6 months. Medication nonadherence is common, but only with the recent advent of e-prescribing has the true extent of nonadherence become apparent. Of these, 106,838 (9.3%) duplicates were excluded (7.2% reissued same day 2.1% Discussion An additional 29,419 patients did not have any filled medication claims during the 2 years spanned by the claims data and thus were included only in secondary analyses.Ī total of 1,147,701 e-prescriptions were written in 2008. There were 280,081 patients who received iScribe e-prescriptions and filled at least 1 prescription claim. During the study period, iScribe e-prescriptions were received by patients in all 50 states the 8 states with the highest volume of iScribe use were New Jersey, New York, Tennessee, Florida, Texas, Maryland, South Carolina, ResultsĪ total of 3634 prescribers used the iScribe system during the 2008 calendar year. Both iScribe and the pharmacy benefit management company are owned and operated by CVS Caremark (Woonsocket, RI). Data were obtained from 2 main sources: (1) iScribe, an e-prescribing system used in outpatient settings, and (2) a large pharmacy benefit management company.
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