title: Greater refill adherence to adalimumab therapy for patients using specialty versus retail pharmacies.
abstract: BACKGROUND
  Retail pharmacies provide regular prescription drugs and some specialty prescription drugs, whereas specialty pharmacies focus on distributing specialty prescription drugs, including tumor necrosis factor (TNF) antagonists. It is unknown whether pharmacy type impacts patients' adherence to anti-TNF therapy. The relationship between pharmacy type (specialty vs. retail) and refill adherence to therapy with the TNF antagonist adalimumab was examined.
  
  
  METHODS
  This was a retrospective analysis of dispensing records of patients in the United States who were prescribed a TNF antagonist (adalimumab 40 mg per 0.8-mL injection) during a dispensation period from January 2003 to August 2009. Patients treated with adalimumab were included in the analysis regardless of diagnosis. For each patient, medication refill adherence (MRA) was calculated as total days of supply divided by total number of days evaluated, multiplied by 100. A regression analysis was conducted in which the dependent variable was MRA and the independent variables included pharmacy type (specialty vs. retail pharmacy), reimbursement/payment type, copayment/payment amount per prescription, age, sex, ethnicity, and annual income.
  
  
  RESULTS
  Of the 86,079 patients included, 70% obtained the medication from a specialty pharmacy, 92% were members of Blue Cross and Blue Shield plans, 67% were women, and 81% were white. The average MRA was 84, and the average age was 52 years. Significant predictors (P<0.05) of MRA included pharmacy type, reimbursement/payment type, copayment/payment amount per prescription, age, sex, and ethnicity; and pharmacy type was the strongest predictor. When other independent variables were controlled for, MRA was 16% less for patients who used a retail pharmacy vs. patients who used a specialty pharmacy.
  
  
  CONCLUSIONS
  Patients who used a specialty pharmacy to fulfill prescriptions for a TNF antagonist had a greater refill adherence than did patients who used a retail pharmacy.
authors.affiliation: Division of Pharmacy Practice and Administration, School of Pharmacy, The University of Missouri-Kansas City, Kansas City, MO 64108, USA, liuyif@umkc.edu
authors.forename: Yifei
authors.initials: Y
authors.lastname: Liu
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.forename: Jingdong
authors.initials: J
authors.lastname: Chao
authors.forename: Parvez M
authors.initials: PM
authors.lastname: Mulani
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D015986:Confounding Factors, Epidemiologic; D004363:Drug Utilization / Q000191:economics / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration; D010594:Pharmacies / Q000458:organization & administration; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States; D016903:Drug Monitoring
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab