title: Persistence with biologic therapies in the Medicare coverage gap.
abstract: OBJECTIVE
  To describe persistence with teriparatide and other biologic therapies in Medicare Part D plans with and without a coverage gap.
  
  
  METHODS
  Retrospective (2006) cohort study of Medicare Part D prescription drug plan beneficiaries from a large benefits company. Two plans with a coverage gap (defined as "basic") were combined and compared with a single plan with coverage for generic and branded medications (defined as "complete").
  
  
  METHODS
  Patients taking alendronate (nonbiologic comparator), teriparatide, etanercept, adalimumab, interferon β-1a, or glatiramer acetate were selected for the study. For patients with complete coverage, equivalent financial thresholds were used to define the "gap."The definition of discontinuation was failure to fill the index prescription after reaching the gap.
  
  
  RESULTS
  For alendronate, 27% of 133,260 patients had enrolled in the complete plan. Patients taking biologic therapies had more commonly enrolled in complete plans: teriparatide (66% of 6221), etanercept (58% of 1469), adalimumab (52% of 824), interferon β-1a (60% of 438), and glatiramer acetate (53% of 393). For patients taking either alendronate or teriparatide, discontinuation rates were higher in the basic, versus complete, plan (adjusted odds ratios, 2.02 and 3.56, respectively). Discontinuation did not significantly vary by plan type for etanercept, adalimumab, interferon β-1a, or glatiramer acetate.
  
  
  CONCLUSIONS
  For patients who reached the coverage gap, discontinuation was more likely for patients taking osteoporosis (OP) medication. Not having a coverage gap was associated with improved persistence with OP treatment.
authors.affiliation: MedMining, a Geisinger Health System Business, Danville, PA 17822-4012, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tamariz
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Uribe
authors.forename: Jiacong
authors.initials: J
authors.lastname: Luo
authors.forename: John W
authors.initials: JW
authors.lastname: Hanna
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ball
authors.forename: Kelly
authors.initials: K
authors.lastname: Krohn
authors.forename: Eric S
authors.initials: ES
authors.lastname: Meadows
mesh_terms: D000068879:Adalimumab; D000368:Aged; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D001691:Biological Therapy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D000068800:Etanercept; D005260:Female; D000068717:Glatiramer Acetate; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010455:Peptides / Q000191:economics / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D019379:Teriparatide / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D010455:Peptides; D018124:Receptors, Tumor Necrosis Factor; D019379:Teriparatide; D000068717:Glatiramer Acetate; D000068879:Adalimumab; D000068800:Etanercept; D019386:Alendronate