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Lower Copays, Mail Orders Close Hypertension Drug Gaps

Taking blood pressure (


Researchers with the health care system Kaiser Permanente in Oakland, California found lower copayments and use of mail-order refills help reduce race and ethnic disparities in drug adherence for patients diagnosed with high blood pressure. The findings on medicine-taking behavior and measures to cut those differences in drug adherence are reported online in the journal Archives of Internal Medicine (paid subscription required).

According to Centers for Disease Control and Prevention, nearly 67 million Americans have high blood pressure, and more than half of them do not have it under control. Kaiser Permanente of Northern California says its hypertension control rate is much higher, with about 87 percent of its members controlling their blood pressure and experiencing reductions in strokes and heart attacks as well.

The team, which included researchers from Kaiser Permanente offices in Denver and Atlanta as well as HealthPartners Research Foundation in Minneapolis, analyzed electronic health records of 44,167 Kaiser Permanente patients who were prescribed blood pressure medications for the first time in 2008. The researchers tallied the incidents of patients’ failure to refill the first prescription and non-adherence to prescribed drug regimens over the next 12 months, and calculated these rates by racial and ethnic groups.

Kaiser Permanente says more than 95 percent of its patients obtain prescriptions from the organization’s in-house pharmacy, and as a result, the researchers were able to monitor if, when, and how the patients studied refilled their hypertension drugs. The findings show nearly all patients picked up their first prescription for hypertension drugs, but refill rates declined soon thereafter.

“In fact,” says research scientist and lead author Alyce Adams, “as early as the first refill, some patients are forgoing their hypertension medication.” More than three in 10 patients overall failed to refill a medication within 90 days of the first prescription, with that rate varying by race and ethnic group. After adjusting for sociodemographic, clinical, and health system factors, about four in 10 Black, Asian, and Hispanic patients (39 to 44%) failed to refill a medication in the first 90 days, compared to about three in 10 (31%) of white patients.

Patients not sticking with their prescribed blood pressure medications were defined as those with gaps in drug refills for more than 20 percent of the days in the 12 months following the start of treatment, or having medication available less than 80 percent of the time. More than a quarter of Blacks (28%) and Hispanics (27%) did not adhere to their drug routines, compared to two in 10 Asians (20%) and 17 percent of white patients.

The team found lower out-of-pocket costs for refills and the use of a mail-order pharmacy reduced the race and ethnic differences in sticking with blood pressure medications. Both lower copayments for drug refills and enrollment in a mail-order pharmacy enrollment were factors strongly associated with higher rates of drug adherence, and helped close the race and ethnic gaps in adherence rates.

“Our findings suggest that while racial and ethnic differences in medication adherence persist, even in settings with high-quality care,” says Adams,  “interventions such as targeted copay reductions and mail-order pharmacy incentives have the potential to reduce these disparities.”

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