Abstract
Background
There are limited studies available analyzing association between copayment and hormonal
contraception adherence. The study was conducted to investigate the association between
copayment status and hormonal contraceptive adherence in a female veteran population
when stratified by socioeconomic status.
Methods
This 4-year, retrospective, cohort study of women Veterans from the Veterans Integrated
Service Network 22, a network of Veterans Affairs facilities that includes Southern
California and Nevada, included patients who received a new hormonal contraceptive
prescription between October 1, 2008, and September 30, 2012. Patients were split
into five quintiles (one having the lowest income and five the highest) dependent
on zip code–based median annual household income from the 2007–2011 American Community
Survey data. Medication possession ratio difference of copayment versus no copayment
group for each respective quintile was the primary outcome. Analysis was done using
multiple linear regression models.
Results
A total of 3,622 patients met the inclusion criteria and were included in the analysis.
Over the entire population, copayment was significantly associated with reduced adherence
(−0.034; 95% confidence interval [CI], −0.06 to −0.008). Patients in the highest socioeconomic
group, quintile five, had the largest reduction in adherence associated with having
a copayment (−0.073; 95% CI, −0.129 to −0.017). Patients in the other four quintiles
saw varying levels of decreased adherence respectively, although the differences did
not achieve statistical significance.
Conclusion
The association between adherence and copayment status varied by socioeconomic status.
Our findings suggest that even affluent patients may be discouraged from adherence
when subject to a copayment. If larger studies substantiate these findings, consideration
should be given to a policy that exempts women veterans from copayments for hormonal
contraceptives.
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Biography
Rashid Kazerooni, PharmD, BCPS, is a Pharmacoeconomics Clinical Specialist for the VA San Diego Healthcare System. He also has adjunct faculty appointments with the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego and University of Pacific Schools of Pharmacy.
Biography
Khanh Vu, BS, is a PharmD candidate at the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego as well as a research assistant for the VA San Diego Healthcare System.
Biography
Atsuhiko Takizawa, BS, is a PharmD candidate at the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego as well as a research assistant for the VA San Diego Healthcare System.
Biography
Christine Broadhead, RN, BSN, is a critical care nurse for Sharp Healthcare System in San Diego, California as well as a licensed Public Health Nurse.
Biography
Anthony P. Morreale, PharmD, MBA, BCPS, is Assistant Chief Consultant for Clinical Pharmacy Services and Healthcare Delivery Services Research nationally for Pharmacy Benefits Management Services within the Department of Veteran Affairs.
Article Info
Publication History
Published online: February 18, 2014
Accepted:
December 10,
2013
Received in revised form:
November 16,
2013
Received:
August 1,
2013
Footnotes
All authors participated in the research, have read the manuscript, and agree with its contents. Article has not been submitted elsewhere. IRB approval was received for this study. There are no relevant financial conflicts of interests to report. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
Copyright
Published by Elsevier Inc.
