title: The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer.
abstract: BACKGROUND
  Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (AIs) in 2010.
  
  
  METHODS
  Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name AIs (BAIs) and/or generic AIs (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80% or greater.
  
  
  RESULTS
  We identified 5511 women, 2815 (51.1%) on BAI, 1411 (25.6%) on GAI, and 1285 (23.3%) who switched from BAI to GAI. The median 30-day copayment was higher for BAI ($33.3) than for GAI ($9.04). In a multivariable Cox-proportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of $15 to $30 (HR = 1.21, 95% CI = 1.01 to 1.44) and more than $30 (HR = 1.49, 95% CI = 1.23 to 1.80) compared with less than $15. In a multivariable logistic regression analysis, adherence (medication possession ratio ≥ 80%) was positively associated with GAI use (odds ratio = 1.53, 95% CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than $100k/year (odds ratio = 1.58, 95% CI = 1.17 to 2.11).
  
  
  CONCLUSIONS
  Higher prescription copayment amount was associated with nonadherence and discontinuation of AIs. After controlling for copayment, discontinuation was higher and adherence was lower with Brand AIs. Because nonadherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.
authors.affiliation: Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM). dlh23@columbia.edu.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.affiliation: Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tsui
authors.affiliation: Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM).
authors.forename: Jay
authors.initials: J
authors.lastname: Meyer
authors.affiliation: Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM).
authors.forename: Sherry
authors.initials: S
authors.lastname: Glied
authors.affiliation: Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM).
authors.forename: Grace Clarke
authors.initials: GC
authors.lastname: Hillyer
authors.affiliation: Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM).
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Department of Medicine, Gynecology and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons (DLH, JW, AIN) and Department of Epidemiology (DLH, JT, GCH, JW, AIN), Mailman School of Public Health, Columbia University, New York, NY; Wagner School of Public Service, New York University, New York, NY (SG); Optum, Eden Prairie, MN (JM).
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000191:economics; D047072:Aromatase Inhibitors / Q000008:administration & dosage* / Q000191:economics; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology*; D003669:Deductibles and Coinsurance / Q000191:economics / Q000706:statistics & numerical data; D016527:Drug Costs; D016568:Drugs, Generic / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D014481:United States; D016903:Drug Monitoring
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D016568:Drugs, Generic