Adherence to Desvenlafaxine Improved with Refill and Save Program

San Diego—The annual prevalence of major depressive disorder (MDD) in the United States is 7% and the lifetime prevalence rate is 16%. Patients with MDD experience depressed mood, fatigue, lack of interest in activities, insomnia or hypersomnia, and other symptoms that have a negative affect on productivity and quality of life.

There are multiple antidepressants indicated for the treatment of MDD, including desvenlafaxine (DVS). Studies have shown that good adherence to antidepressant therapy is associated with improved outcomes, yet adherence to those agents remains low, according to researchers.

In October 2009, a large US health plan began a Refill and Save Program (RSP) to promote better adherence. The program linked a copayment discount to adherence by reducing the member’s copayment for DSV prescriptions when refilled within 30 days following the end of the previous antidepressant fill. The discount was $20 for retail prescriptions and $50 for those filled via mail order.

Researchers recently conducted an analysis to determine the association of the copayment discount program for DVS with adherence and healthcare costs by comparing data between plan members with and without RSP benefits. They reported results of the analysis during a poster session at the AMCP meeting. The poster was titled Impact of Refill and Save Program on Adherence to Desvenlafaxine and Healthcare Costs.

The analysis utilized a sample of commercially insured health plan members ≥18 years of age with ≥1 claim for DSV during the first 6 months of the RSP (October 2009-March 2012; identification period [ID]). The index date was defined as the date of the first pharmacy claim for DSV during the ID period. Adherence was measured as proportion of days covered (PDC) with DSV, presented as a percentage.

Based on RSP benefit status during the index period, 11,820 members were divided into RSP (n=7463) and non-RSP (n=4357) cohorts. Naïve users were defined as those who did not have pharmacy claims for DSV during baseline (n=2792 in the RSP cohort and n=1982 in the non-RSP cohort); current users were defined as those who had ≥1 pharmacy claim for DSV during baseline (n=4671 in the RSP cohort and n=2375 in the non-RSP cohort).

Overall, mean age was 45 years, 75.7% were female, and 4774 were naïve DSV users.

After adjustment for covariates, PDC was 7.4 percentage points higher in the RSP cohort than in the non-RSP cohort, 6.1 percentage points higher among naïve RSP members relative to naïve non-RSP members, and 8.1 percentage points higher among current RSP members versus current non-RSP members (P<.001 for all comparisons).

Adjusted total healthcare costs were 10% lower in the RSP cohort compared with the non-RSP cohort (P=.007), and 12% lower among naïve RSP members relative to naïve non-RSP members (P=.016). There was no significant difference in total healthcare costs between the RSP and non-RSP cohorts in the current DSV user subgroup.

In summary, the researchers said, “Members in the RSP cohort, versus the non-RSP cohort, had significantly higher adherence to DSV. RSP members who were naïve to DSV had significantly lower total healthcare costs compared with naïve non-RSP members.”