State and Regional Variation in Prescription- and Payment-Related Promoters of Adherence to Blood Pressure Medication
ORIGINAL RESEARCH — Volume 17 — September 24, 2020
PEER REVIEWED
Figure 1. Concentration ratios of adherence promotion factors related to prescriptions among the largest market segments, by US Census region, 2017. Data source: 2017 Symphony Health Integrated Dataverse (15). Abbreviations: NP, nurse practitioner; PA, physician assistant; PCP, primary care physician.
| Promoter | Age Group, Years | Market Segment | Northeast | Midwest | South | West |
|---|---|---|---|---|---|---|
| Fixed-dose combination fills | 18-64 | PCP/Commercial | 1.13 | 1.30 | 1.49 | 1.09 |
| NP and PA/Commercial | 0.89 | 1.06 | 1.34 | 0.91 | ||
| PCP/Medicaid | 0.78 | 0.81 | 0.86 | 0.51 | ||
| Other Combinations | 0.60 | 0.78 | 0.65 | 0.82 | ||
| ≥65 | PCP/Medicare | 0.96 | 1.06 | 1.22 | 0.92 | |
| PCP/Commercial | 1.25 | 1.38 | 1.56 | 1.24 | ||
| Cardiologist/Medicare | 0.51 | 0.41 | 0.58 | 0.48 | ||
| Other Combinations | 0.81 | 1.00 | 0.52 | 0.75 | ||
| Fills acquired via mail order | 18-64 | PCP/Commercial | 2.09 | 1.79 | 1.06 | 1.19 |
| NP and PA/Commercial | 1.62 | 1.28 | 0.77 | 0.89 | ||
| PCP/Medicaid | 0.03 | 0.05 | 0.15 | 0.04 | ||
| Other Combinations | 0.92 | 0.94 | 0.81 | 1.00 | ||
| ≥65 | PCP/Medicare | 0.45 | 1.01 | 0.94 | 0.69 | |
| PCP/Commercial | 2.57 | 2.74 | 1.62 | 1.73 | ||
| Cardiologist/Medicare | 0.46 | 0.83 | 0.74 | 0.62 | ||
| Other Combinations | 0.69 | 0.75 | 0.53 | 0.66 | ||
| Days’ supply per fill, mean | 18-64 | PCP/Commercial | 1.12 | 1.11 | 1.05 | 0.97 |
| NP and PA/Commercial | 1.05 | 1.04 | 0.97 | 0.92 | ||
| PCP/Medicaid | 0.77 | 0.77 | 0.76 | 0.84 | ||
| Other Combinations | 0.99 | 0.94 | 1.00 | 0.97 | ||
| ≥65 | PCP/Medicare | 0.99 | 1.07 | 1.02 | 1.06 | |
| PCP/Commercial | 1.07 | 1.08 | 0.99 | 0.97 | ||
| Cardiologist/Medicare | 1.05 | 1.03 | 0.97 | 1.04 | ||
| Other Combinations | 0.99 | 0.92 | 0.95 | 0.94 |
Figure 2. Concentration ratios of adherence promotion factors related to payments among the largest market segments, by US Census region, 2017. Data source: 2017 Symphony Health Integrated Dataverse (15). Abbreviations: NP, nurse practitioner; PA, physician assistant; PCP, primary care physician.
| Promoter | Age Group, Years | Market Segment | Northeast | Midwest | South | West |
|---|---|---|---|---|---|---|
| Fills for generic formulations | 18-64 | PCP/Commercial | 0.99 | 1.00 | 1.00 | 1.00 |
| NP and PA/Commercial | 1.00 | 1.00 | 1.00 | 1.01 | ||
| PCP/Medicaid | 1.02 | 1.02 | 1.01 | 1.02 | ||
| Other Combinations | 0.99 | 0.99 | 1.00 | 1.00 | ||
| ≥65 | PCP/Medicare | 1.01 | 1.01 | 1.01 | 1.01 | |
| PCP/Commercial | 0.98 | 0.99 | 0.99 | 1.00 | ||
| Cardiologist/Medicare | 0.98 | 0.99 | 0.99 | 0.98 | ||
| Other Combinations | 1.00 | 1.00 | 1.00 | 1.00 | ||
| Fills with lower or no copayment | 18-64 | PCP/Commercial | 0.88 | 0.84 | 0.86 | 0.91 |
| NP and PA/Commercial | 0.92 | 0.88 | 0.91 | 0.95 | ||
| PCP/Medicaid | 1.45 | 1.49 | 1.48 | 1.49 | ||
| Other Combinations | 1.07 | 0.97 | 1.07 | 0.91 | ||
| ≥65 | PCP/Medicare | 1.08 | 1.06 | 1.11 | 1.12 | |
| PCP/Commercial | 0.79 | 0.74 | 0.81 | 0.83 | ||
| Cardiologist/Medicare | 0.96 | 1.02 | 1.04 | 1.03 | ||
| Other Combinations | 1.03 | 0.97 | 1.11 | 1.02 | ||
| Out-of-pocket spending per therapy year | 18-64 | PCP/Commercial | 1.01 | 1.04 | 1.22 | 1.07 |
| NP and PA/Commercial | 1.00 | 1.06 | 1.20 | 1.06 | ||
| PCP/Medicaid | 0.23 | 0.16 | 0.22 | 0.10 | ||
| Other Combinations | 0.93 | 0.92 | 1.07 | 0.91 | ||
| ≥65 | PCP/Medicare | 0.86 | 0.81 | 0.78 | 0.73 | |
| PCP/Commercial | 1.14 | 1.18 | 1.29 | 1.18 | ||
| Cardiologist/Medicare | 1.09 | 0.97 | 1.03 | 1.01 | ||
| Other Combinations | 1.16 | 1.20 | 1.23 | 1.12 |