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Sofosbuvir Initial Therapy Abandonment and Manufacturer Coupons in a Commercially Insured Population
Taruja D. Karmarkar, MHS; Catherine I. Starner, PharmD; Yang Qiu, MS; Kirsten Tiberg, RPh; and Patrick P. Gleason, PharmD
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Sofosbuvir Initial Therapy Abandonment and Manufacturer Coupons in a Commercially Insured Population

Taruja D. Karmarkar, MHS; Catherine I. Starner, PharmD; Yang Qiu, MS; Kirsten Tiberg, RPh; and Patrick P. Gleason, PharmD
Member cost negatively affects initial medication adherence and manufacturer coupons can decrease member share by up to 98%.
Members with a sofosbuvir pharmacy benefit insurance transaction—where the pharmacy receives the prescription and is adjudicated with the insurer—were categorized as either initial medication adherence or as abandoning therapy if sofosbuvir was never picked up by the member and returned to pharmacy stock. Members were placed into cost-share groups based on the amount of insurer-required cost share from their index sofosbuvir claim: <$50; $50 to <$100; $100 to <$250; $250 to <$1000; $1000 to <$2500; $2500 to <$5000; $5000 to <$10,000; and $10,000 or more. Sofosbuvir initial therapy abandonment was categorized by member cost group. The member cost shares are unadjusted for coupons because that information was unavailable for all members in the analysis.
To evaluate the impact of a coupon on insurer-required member cost, we conducted a subgroup analysis limited to the members filling their index sofosbuvir at a particular specialty pharmacy for which we had coupon data available. Claims data from the pharmacy benefit manager were merged at a member level with coupon records from the specialty pharmacy to examine the impact of the coupon on the member’s cost. By linking data from the specialty pharmacy to the pharmacy benefit manager’s claim records, we were able to identify sofosbuvir index claims that had been filled with the use of a coupon. We compared the member’s cost as defined by the insurer with the true member cost after the coupon was applied.
Statistical Analyses
After stratifying by initial sofosbuvir member cost group, we used descriptive statistics to examine differences in member characteristics, including age and gender; education, income, and race at a zip-code level, derived from Census Bureau information; Optum pharmacy risk group score,14 which measures disease burden; index sofosbuvir claim filled at the specialty pharmacy; and total drug costs (health insurer plus member amount) for non-sofosbuvir pharmacy claims in 2014. A Cochran-Armitage trend test was performed to evaluate the trend in abandonment rates as the member cost increased. The member group in which the initial cost of sofosbuvir without coupon adjustment was <$50 was used as the reference group for univariate abandonment rate comparisons.
Descriptive statistics were used to examine the proportion of members who used drug coupons and how much these coupons reduced member cost. We could not assess the relationship between abandonment and coupons because no member who abandoned therapy had presence of a coupon on their index claim.
Finally, we used multivariate logistic regression to examine the impact of a member’s cost on abandonment using the same <$50 group as the reference group, and controlling for the same member characteristics above. The overall fit of the logistic regression model was evaluated using the C statistic. All statistical tests were performed using SAS version 9.1.3 (SAS Institute Inc, Cary, North Carolina) and significance was set a priori at P <.05.
Between January 1 and September 30, 2014, we identified 3991 members who met study criteria for attempting a sofosbuvir pharmacy claim transaction and were continuously enrolled for 90 days after the index claim. The majority of members had an insurer-required cost share of less than $250 for their index sofosbuvir claim. Specifically, 1132 (28.4%), 743 (18.6%), and 809 (20.3%) were in the $0 to <$50, $50 to <$100, and $100 to <$250 member cost groups, respectively. Five percent of members (201) were exposed to a cost of more than $10,000. Table 1 summarizes member characteristics by insurer-required member cost group.
Overall, the index sofosbuvir abandonment rate was 7.4%. The Figure shows that the unadjusted proportion of members abandoning sofosbuvir therapy starts out at 3.8% in the $0 to <$50 member cost group and stays below 8% up to the $5000 to <$10,000 cost group. At member cost of $10,000 or more, 52.7% of members abandoned sofosbuvir therapy. The unadjusted abandonment rate was statistically significant at $2500 when compared with <$50 member cost (P <.05).

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