Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Georgetown University School of Health, Department of Health Management and Policy, Washington, DC.
J Manag Care Spec Pharm. 2024 Sep;30(9):903-907. doi: 10.18553/jmcp.2024.30.9.903.
Patients often use manufacturer-sponsored coupons to reduce their out-of-pocket spending. However, little is known whether coupon use is associated with medication-switching behaviors.
To examine if using a manufacturer-sponsored coupon to initiate a medication is associated with patterns of medication-switching behaviors among patients with type 2 diabetes.
Using IQVIA's retail pharmacy claims data from October 2017 to September 2019, we analyzed commercially insured patients with type 2 diabetes who had newly started taking the following noninsulin diabetes drugs: generic metformin (nearly no coupon use), Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors (SGLT2, high coupon use), and dipeptidyl peptidase IV inhibitors (DPP-IV inhibitors, moderate coupon use). We assessed if drug-switching behaviors, defined as no switching, switching to a same-class drug, or switching to a drug in a different class, differed among patients who did and did not use coupons to initiate treatments. We performed multinomial logistic regression to estimate the probability of each switching type associated with patients' initial coupon use.
Among 9,781 patients in our sample, 83.7% of them initiated treatments with metformin, 8.2% with SGLT2, and 8.1% with DPP-IV inhibitors. The overall switching rate was the lowest for generic metformin (40%) than brand-name drugs (56%-57%). Among the brand-name drug users, patients who used a coupon to initiate these drugs were less likely to switch to any drug compared with patients without coupon use (SGLT2 = -18% [95% CI = -24% to -13%]; DPP-IV inhibitors = -9% [-16% to -2%]). These patients were also less likely to switch to drugs in other competing classes (SGLT2 = -16% [95% CI = -22% to -10%]; DPP-IV inhibitors = -9% [-16% to -2%]).
Patients who started their treatment with generic metformin had the lowest rate of drug switching. Using coupons to initiate brand-name drugs in classes with prevalent coupons was associated with reduced medication switching to other class drugs.
患者经常使用制造商赞助的优惠券来降低自付费用。然而，对于优惠券的使用是否与药物更换行为有关，知之甚少。
研究使用制造商赞助的优惠券启动药物治疗是否与 2 型糖尿病患者的药物更换行为模式相关。
利用 IQVIA 从 2017 年 10 月至 2019 年 9 月的零售药房理赔数据，分析新开始使用以下非胰岛素糖尿病药物的商业保险患者：通用二甲双胍（几乎没有优惠券使用）、钠-葡萄糖协同转运蛋白 2（SGLT2，高优惠券使用）和二肽基肽酶-4 抑制剂（DPP-IV 抑制剂，中等优惠券使用）。我们评估了药物更换行为，定义为不更换、更换为同类药物或更换为不同类别的药物，在使用和不使用优惠券启动治疗的患者中是否存在差异。我们进行了多项逻辑回归，以估计每种转换类型与患者初始优惠券使用相关的概率。
在我们的样本中，9781 名患者中，83.7%的患者开始使用二甲双胍治疗，8.2%的患者开始使用 SGLT2 治疗，8.1%的患者开始使用 DPP-IV 抑制剂治疗。总体更换率最低的是通用二甲双胍（40%），而不是品牌药物（56%-57%）。在使用品牌药物的患者中，与没有使用优惠券的患者相比，使用优惠券启动这些药物的患者不太可能更换任何药物（SGLT2 = -18% [95%CI=-24%至-13%]；DPP-IV 抑制剂 = -9% [-16%至-2%]）。这些患者也不太可能更换其他竞争类别药物（SGLT2 = -16% [95%CI=-22%至-10%]；DPP-IV 抑制剂 = -9% [-16%至-2%]）。
开始使用通用二甲双胍治疗的患者药物更换率最低。使用优惠券启动有普遍优惠券的品牌药物与减少更换其他类别药物的药物治疗相关。
