title: Association of Part D coverage gap with COPD medication adherence.
abstract: This study assessed the association of the Medicare Part D coverage gap with medication adherence among beneficiaries with chronic obstructive pulmonary disease (COPD).
  
  
  
  Retrospective observational study based on Medicare claims data.
  
  
  
  A 5% random sample of Medicare claims data (2006-2010) was used in this study. Beneficiaries diagnosed with COPD and treated with long-acting bronchodilators (LABDs) were assigned to an exposure cohort (at risk of the coverage gap) or a control cohort (otherwise). The exposure and control cohorts were matched using high-dimensional propensity scores. Adherence was defined as ≥80% of the proportion of days covered by LABDs. Logistic regressions controlling for unbalanced covariates post matching were applied to assess the association of the coverage gap with adherence.
  
  
  
  The final matched exposure and control cohorts each included 4147 patient-year observations with about 42% and 46% of them adherent to LABDs, respectively. About 17% of the exposure cohort hit the coverage gap after October 31. Logistic regression showed that, compared with the control cohort, the beneficiaries in the exposure cohort had a significantly lower likelihood of being adherent if they hit the coverage gap later in the year (odds ratio [OR], 0.603; 95% CI, 0.493-0.738), or had a lower likelihood without statistical significance if otherwise (OR, 0.931; 95% CI, 0.846-1.024).
  
  
  
  The findings suggest that the Part D coverage gap was associated with lower adherence in patients with COPD, which may serve as evidentiary support for phasing out the coverage gap by 2020.
authors.affiliation: Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Rd, Ridgefield, CT 06877. E-mail: yanni.yu@boehringer-ingelheim.com.
authors.forename: Yanni F
authors.initials: YF
authors.lastname: Yu
authors.forename: Larry R
authors.initials: LR
authors.lastname: Hearld
authors.forename: Haiyan
authors.initials: H
authors.lastname: Qu
authors.forename: Midge N
authors.initials: MN
authors.lastname: Ray
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D / Q000191:economics / Q000592:standards*; D015999:Multivariate Analysis; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D014481:United States; D016903:Drug Monitoring
chemical_list: D001993:Bronchodilator Agents