Higher Copays Increase Abandonment Rates of Treatment

Darshan Mehta, PhD, of Sunovion Pharmaceuticals, recently explained why increasing copays result in higher prescription abandonment rates among patients prescribed antiepileptic drugs (AED), during a session at the ISPOR annual meeting. 

Dr Mehta kicked off the session by providing the audience a brief background about epilepsy in the United States. He explained that it is the fourth most common neurologic disease and it often affects young children and older adults at the highest rates. Dr Metha said that focal seizures account for roughly 60% of pediatric epilepsy cases and generalized seizures account for almost 40% of cases. Further, he explained that AED therapy is the primary treatment option, and he noted that in order to manage the cost of AEDs, formulary managers will employ high out-of-pocket copayments. He finally explained that by increasing patient cost sharing, declines in medication adherence are reported. 

Dr Mehta said, “The impact of patient copay on the likelihood of abandonment of prescribed AED has not been studied in pediatric patients with focal seizures.” 

To understand abandonment rates among patients with focal seizures, Dr Mehta and a team of researchers analyzed the association between patient copay and the likelihood of AED prescription abandonment. 

Dr Mehta and his team observed patients from April 1, 2015 through July 30, 2018. During this time, they observed patients over a 6-month baseline period as well as a 6-month follow-up period. During the baseline period, the researchers examined demographic and clinical characteristics as well as AED-related characteristics. Specifically, they looked at: 

• Demographic characteristics 
• Patient gender 
• Patient age 
• US census region 
• Payer 
• Clinical characteristics 
• Comorbidities 
• Healthcare research utilization and cost 
• AED-related characteristics 
• Number of AEDs 
• Generic treatment vs branded treatment. 

During the follow-up period, the research team examined rates of prescription abandonment. The researchers were interested to see if there was a reversal of the initially approved claim with no subsequent fill during the follow-up period. They studied for “index and any AED.” 

The researchers found that increasing copay resulted in higher abandonment rates of AEDs, Dr Mehta explained. 

He explained to attendees, “Prescription abandonment, possibly driven by higher copay, may negatively impact the ability of clinicians to attain seizure control for their pediatric patients.” 

“Future research should examine the impact of the prescription abandonment on clinical and economic outcomes.” —Julie Gould