High copays lower odds of ‘optimal adherence’ to lupus treatment
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PHILADELPHIA — Among patients with lupus, those with higher copays are more likely to demonstrate poor treatment adherence, according to data presented at ACR Convergence 2022.
“Treatment non-adherence is a barrier to improvement in lupus,” Raisa Lomanto Silva, MD, of the University of Pittsburgh Medical Center, told attendees. “Decrease or elimination of copay has been shown to improve outcomes in other chronic illnesses. So, our goal with this work was to investigate possible associations of medication copay with treatment adherence in lupus.”
Silva and colleagues noted that studies have investigated treatment adherence in systemic lupus erythematosus. “But most of these studies focus on hydroxychloroquine only,” she said.
In the current analysis, they aimed to investigate potential associations between medication copays and adherence not only to hydroxychloroquine, but azathioprine and mycophenolate mofetil (MMF), as well.
Findings from Optum’s deidentified Clinformatics Data Mart Database were used in the study. They identified 12,510 eligible participants overall, which included 9,510 patients receiving hydroxychloroquine alone, with the remainder receiving hydroxychloroquine with one of the other drugs.
The patient population had a mean age of 54 years. The cohort was 88% women, 63% white and approximately 15% Black, according to Silva. Patients treated between 2010 and 2019 were included.
Copays were assessed based on price per 30 days, with less than $10 for 30 days on the low end and $10 or more for 30 days on the high end.
According to the researchers, median 30-day copays were $8 (interquartile range = $4 to $8) for hydroxychloroquine, $7 (IQR = $2 to $10) for azathioprine and $10 (IQR = $5 to $20) for MMF.
The researchers reported “significant associations” between higher copays and lower adherence. Specifically, adjusted model results demonstrated that copays in the high category were associated with 39% (95% CI, 0.55-0.68) lower odds of adherence for hydroxychloroquine, 56% (95% CI, 0.29-0.65) lower odds of adherence for azathioprine and 32% (95% CI 0.49-0.96) lower odds of adherence for MMF.
“We identified an association between high copays and lower odds of optimal adherence for some of the most commonly prescribed medications for lupus,” Silva said. “We strongly believe that awareness of financial burden that copays pose on patients and their consequences on adherence is essential to improve medication access.”
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Silva RL. Abstract 1115. Presented at: ACR Convergence 2022; Nov. 11-14, 2022; Philadelphia (hybrid meeting).
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