Participation in an innovative patient support program reduces prescription abandonment for adalimumab-treated patients in a commercial population

Abstract

Purpose: Nonadherence to indicated therapy reduces treatment effectiveness and may increase cost of care. HUMIRA Complete, a Patient Support Program (PSP), aims to reduce nonadherence in patients prescribed adalimumab (ADA). The objective of this study was to assess the relationship between participation in the PSP and prescription abandonment rates among ADA-treated patients.

Patients and methods: This longitudinal study using patient-level data from AbbVie's PSP linked with medical and pharmacy claims data included patients ≥18 years with an ADA-approved indication, ≥1 pharmacy claim for ADA, and available data ≥3 months before and ≥6 months after the index date (defined as the initial ADA claim [01/2015 to 02/2017]). Abandonment was defined as reversal of initial ADA prescription with no paid claim during 3-month follow-up. Abandonment rates were compared between PSP and non-PSP cohorts using multivariable logistic regression controlling for potentially confounding baseline characteristics.

Results: In 17,371 patients (9,851 PSP; 7,520 non-PSP), the overall abandonment rate was 10.8-16.8% across indications. The odds of ADA abandonment were 70% less for PSP vs non-PSP patients (5.6% vs 20.4%, odds ratio [OR]=0.30, [95% confidence interval (CI)=0.27-0.33] P<0.001), 38% less for patients using specialty vs retail pharmacy (OR=0.62, 95% CI=0.56-0.69, P<0.001), 20% less for those with income of $50-99K vs $0-49K (OR=0.80, 95% CI=0.69-0.92, P<0.01), and 78% greater for those with copayment of $26-100 vs $0-25 (OR=1.78, 95% CI=1.55-2.05, P<0.001).

Conclusion: Participation in the PSP, higher income, and using a specialty pharmacy were associated with lower odds of abandoning ADA therapy, whereas increased copayments were associated with greater abandonment. PSPs should be considered to improve initiation of ADA therapy.

Keywords: adherence; drug utilization; managed care; outcomes research/analysis; patient education; personnel management.

Figure 1

Study sample selection. Notes: ^aDirect feed claims consisted of filled claims only and were excluded from abandonment analysis. The following treatments were included: etanercept, infliximab, certolizumab, golimumab, anakinra, tocilizumab, secukinumab, ixekizumab, ustekinumab, abatacept, rituximab, natalizumab, vedolizumab, tofacitinib, and apremilast. ^bClaims with government-provided insurance were excluded as these patients were prohibited from using all components of the PSP. ^cDetermined using all available claims from 1/1/2006 to the index date. ^dAutoimmune diseases included rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, psoriatic arthritis, ankylosing spondylitis, hidradenitis suppurativa, and uveitis. Abbreviations: ADA, adalimumab; AS, ankylosing spondylitis; HS, hidradenitis suppurativa; IBD, inflammatory bowel disease; PsA, psoriatic arthritis; PsO, psoriasis; PSP, patient support program; RA, rheumatoid arthritis; UV, uveitis.

Figure 2

Prevalence of abandonment by PSP participation for the overall study population and individual indications. Notes: Relative percent change = (PSP–Non-PSP)/Non-PSP. Asterisk (*) indicates the comparison of PSP versus non-PSP cohorts was statistically significant (P<0.001). P-value was based on 2-sample z-test of proportions. Abbreviations: AS, ankylosing spondylitis; HS, hidradenitis suppurativa; IBD, inflammatory bowel disease; PsA, psoriatic arthritis; PsO, psoriasis; RA, rheumatoid arthritis; UV, uveitis.