Participation in an innovative patient support program reduces prescription abandonment for adalimumab-treated patients in a commercial population

Figures & data

Figure 1 Study sample selection.

Notes: ^aDirect feed claims consisted of filled claims only and were excluded from abandonment analysis. The following treatments were included: etanercept, infliximab, certolizumab, golimumab, anakinra, tocilizumab, secukinumab, ixekizumab, ustekinumab, abatacept, rituximab, natalizumab, vedolizumab, tofacitinib, and apremilast. ^bClaims with government-provided insurance were excluded as these patients were prohibited from using all components of the PSP. ^cDetermined using all available claims from 1/1/2006 to the index date. ^dAutoimmune diseases included rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, psoriatic arthritis, ankylosing spondylitis, hidradenitis suppurativa, and uveitis.
Abbreviations: ADA, adalimumab; AS, ankylosing spondylitis; HS, hidradenitis suppurativa; IBD, inflammatory bowel disease; PsA, psoriatic arthritis; PsO, psoriasis; PSP, patient support program; RA, rheumatoid arthritis; UV, uveitis.

Table 1 Baseline characteristics of the study population

Characteristic	PSP N=9851	Non-PSP N=7520	P-value^a
Age (years), mean ± SD	45.6±13.3	46.4±13.9	<0.001
Male, n (%)	3817 (38.7)	2935 (39.0)	0.71
Household income, n (%)
$0–$49,999	1694 (17.2)	1486 (19.8)	<0.001
$50,000–$99,999	2778 (28.2)	2106 (28.0)	0.78
>$100,000	2402 (24.4)	1480 (19.7)	<0.001
Unknown	2977 (30.2)	2448 (32.6)	<0.001
Expected patient copay, mean ± SD	$344±$1601	$627±$2042	<0.001
$0–$25, n (%)	7685 (78.0)	4183 (55.6)	<0.001
$26–$100, n (%)	902 (9.2)	1581 (21.0)	<0.001
$101–$500, n (%)	437 (4.4)	586 (7.8)	<0.001
$501–$1000, n (%)	150 (1.5)	225 (3.0)	<0.001
$1001–$2000, n (%)	160 (1.6)	195 (2.6)	<0.001
>$2000, n (%)	517 (5.2)	750 (10.0)	<0.001
Calendar year, n (%)
2015	6152 (62.5)	5146 (68.4)	<0.001
2016	3699 (37.5)	2374 (31.6)	<0.001
Primary plan, n (%)
Commercial	3794 (38.5)	475 (6.3)	<0.001
Employer group	584 (5.9)	703 (9.3)	<0.001
Third party administrator	27 (0.3)	47 (0.6)	<0.001
Pharmacy benefit manager	1887 (19.2)	2432 (32.3)	<0.001
Cash	180 (1.8)	361 (4.8)	<0.001
Processors	41 (0.4)	71 (0.9)	<0.001
Unspecified or missing	3338 (33.9)	3431 (45.6)	<0.001
Initial claim at specialty pharmacy, n (%)^b	7443 (75.6)	3938 (52.4)	<0.001
Charlson Comorbidity Index, mean ± SD	0.38±0.70	0.47±0.84	<0.001
Indications, n (%)
Inflammatory bowel disease	4046 (41.1)	2446 (32.5)	<0.001
Rheumatoid arthritis	2475 (25.1)	2254 (30.0)	<0.001
Psoriasis	1844 (18.7)	1412 (18.8)	0.92
Psoriatic arthritis	813 (8.3)	750 (10.0)	<0.001
Ankylosing spondylitis	246 (2.5)	304 (4.0)	<0.001
Hidradenitis suppurativa	314 (3.2)	217 (2.9)	0.25
Uveitis	113 (1.1)	137 (1.8)	<0.001

Notes: ^aWilcoxon rank-sum tests and chi-square tests were used to compare continuous and categorical variables, respectively. ^bDefined as a pharmacy type of mail order/specialty.

Abbreviations: PSP, patient support program; SD, standard deviation.

Figure 2 Prevalence of abandonment by PSP participation for the overall study population and individual indications.

Notes: Relative percent change = (PSP–Non-PSP)/Non-PSP. Asterisk (*) indicates the comparison of PSP versus non-PSP cohorts was statistically significant (P<0.001). P-value was based on 2-sample z-test of proportions.
Abbreviations: AS, ankylosing spondylitis; HS, hidradenitis suppurativa; IBD, inflammatory bowel disease; PsA, psoriatic arthritis; PsO, psoriasis; RA, rheumatoid arthritis; UV, uveitis.

Table 2 Multivariable analysis of the odds of abandonment of treatment with ADA

Characteristic	All indications
	Odds ratio(95% CI)	P-value
Opt-in to PSP^a	0.30 (0.27–0.33)	<0.001
Age (years)	1.01 (1.01–1.01)	<0.001
Male	0.92 (0.83–1.02)	0.12
Household income
$0–$49,999	Ref	—
$50,000–$99,999	0.80 (0.69–0.92)	<0.01
≥$100,000	0.76 (0.65–0.90)	<0.001
Unknown	0.87 (0.75–1.00)	<0.05
Expected patient copay
$0–$25	Ref	—
$26–$100	1.78 (1.55–2.05)	<0.001
$101–$500	2.56 (2.13–3.08)	<0.001
$501–$1000	5.08 (3.98–6.49)	<0.001
$1001–$2000	8.28 (6.52–10.52)	<0.001
>$2000	9.75 (8.27–11.49)	<0.001
Calendar year
2015	0.89 (0.80–0.99)	0.04
2016	Ref	—
Primary plan
Commercial	Ref	—
Employer group	1.47 (1.18–1.83)	<0.001
Third party administrator	1.12 (0.56–2.24)	0.74
Pharmacy benefit manager	1.09 (0.91–1.31)	0.35
Cash	0.87 (0.66–1.15)	0.33
Processors	1.70 (1.07–2.70)	0.02
Unspecified or missing	1.14 (0.96–1.36)	0.12
Initial claim at specialty pharmacy	0.62 (0.56–0.69)	<0.001
Charlson Comorbidty Index	1.01 (0.95–1.08)	0.74
Indications
Rheumatoid arthritis	Ref	—
Inflammatory bowel disease	1.37 (1.19–1.58)	<0.001
Psoriasis	1.30 (1.11–1.53)	<0.001
Psoriatic arthritis	0.99 (0.81–1.22)	0.95
Ankylosing spondylitis	1.18 (0.88–1.58)	0.26
Hidradenitis suppurativa	1.98 (1.50–2.61)	<0.001
Uveitis	0.92 (0.59–1.43)	0.71

Note: ^aNon-PSP cohort was the reference.

Abbreviations: ADA, adalimumab; CI, confidence interval; PSP, patient support program; Ref, reference.

Table 3 Multivariable analysis of the odds of abandonment of treatment with ADA by indication

Characteristic	IBD	RA	PsO	PsA	AS	HS	UV
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Opt-in to PSP^a	0.28 (0.24–0.34)***	0.34 (0.27–0.42)***	0.27 (0.20–0.35)***	0.34 (0.22–0.52)***	0.24 (0.11–0.50)***	0.25 (0.14–0.45)***	0.18 (0.05–0.67)*
Age (years)	1.01 (1.00–1.02)**	1.01 (1.00–1.02)*	1.01 (1.00–1.02)	1.02 (1.00–1.04)*	1.02 (0.99–1.04)	1.01 (0.99–1.04)	1.05 (1.01–1.10)*
Male	0.78 (0.65–0.92)**	1.03 (0.82–1.31)	1.14 (0.90–1.43)	0.93 (0.64–1.35)	0.57 (0.32–1.01)	0.92 (0.51–1.67)	2.58 (0.89–7.50)
Household income
$0–$49,999	Ref	Ref	Ref	Ref	Ref	Ref	Ref
$50,000–$99,999	1.03 (0.80–1.32)	0.66 (0.51–0.86)**	0.73 (0.52–1.03)	0.57 (0.33–0.98)*	1.24 (0.57–2.71)	0.72 (0.35–1.49)	1.80 (0.32–10.17)
≥$100,000	0.78 (0.60–1.03)	0.65 (0.48–0.89)**	0.92 (0.64–1.31)	0.85 (0.49–1.47)	0.49 (0.20–1.21)	0.88 (0.33–2.32)	1.30 (0.21–7.91)
Unknown	0.92 (0.72–1.18)	0.75 (0.58–0.98)*	0.99 (0.71–1.38)	0.94 (0.55–1.61)	0.48 (0.20–1.16)	0.99 (0.50–1.97)	3.04 (0.58–15.94)
Expected patient copay
$0–$25	Ref	Ref	Ref	Ref	Ref	Ref	Ref
$26–$100	1.82 (1.45–2.28)***	1.74 (1.32–2.31)***	2.01 (1.46–2.75)***	1.33 (0.77–2.30)	1.07 (0.46–2.49)	2.39 (1.20–4.78)*	1.24 (0.37–4.17)
$101–$500	1.79 (1.28–2.49)***	2.92 (2.03–4.21)***	3.10 (2.11–4.55)***	3.16 (1.69–5.91)***	4.09 (1.37–12.17)*	2.63 (1.06–6.55)*	10.85 (2.22–53.04)**
$501–$1000	3.90 (2.41–6.30)***	6.15 (4.11–9.20)***	4.19 (2.39–7.36)***	7.48 (3.09–18.11)***	6.23 (1.75–22.14)**	2.61 (0.29–23.37)	55.52 (2.40–999.99)*
$1001–$2000	5.03 (3.10–8.17)***	11.72 (7.78–17.65)***	8.13 (4.89–13.50)***	13.34 (6.27–28.40)***	4.16 (0.76–22.75)	11.78 (1.79–77.50)*	2.18 (0.12–38.78)
>$2000	10.27 (7.95–13.27)***	9.60 (6.77–13.61)***	9.62 (6.59–14.05)***	13.00 (7.37–22.94)***	4.85 (1.59–14.79)**	11.98 (5.31–27.00)*	4.68 (0.39–55.75)
Calendar year
2015	0.83 (0.70–0.99)*	0.90 (0.73–1.11)	0.87 (0.68–1.10)	1.15 (0.75–1.76)	0.69 (0.37–1.28)	1.15 (0.68–1.96)	1.20 (0.43–3.35)
2016	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Primary plan
Commercial	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Employer group	1.33 (0.91–1.92)	1.33 (0.88–2.00)	1.60 (0.95–2.68)	2.30 (1.01–5.25)*	1.90 (0.58–6.27)	1.01 (0.36–2.90)	7.14 (0.74–68.95)
TPA	1.33 (0.38–4.65)	1.26 (0.37–4.31)	0.58 (0.11–3.16)	3.10 (0.24–39.60)	—	0.93 (0.06–15.01)	—
PBM	1.05 (0.77–1.42)	1.17 (0.83–1.66)	0.95 (0.62–1.46)	1.16 (0.57–2.36)	1.32 (0.51–3.44)	0.57 (0.24–1.38)	7.40 (1.02–53.63)*
Cash	0.53 (0.32–0.87)*	0.81 (0.47–1.39)	1.08 (0.57–2.03)	2.98 (1.13–7.90)*	2.52 (0.60–10.48)	0.33 (0.07–1.66)	4.36 (0.16–120.84)
Processors	1.77 (0.92–3.40)	1.91 (0.62–5.87)	1.56 (0.38–6.39)	2.14 (0.48–9.46)	0.62 (0.03–12.08)	0.54 (0.08–3.72)	—
Unspecified or missing	1.20 (0.90–1.59)	1.20 (0.87–1.67)	1.10 (0.74–1.63)	1.51 (0.79–2.92)	0.52 (0.19–1.41)	0.46 (0.20–1.07)	1.67 (0.22–12.58)
Initial claim at SP	0.57 (0.48–0.68)***	0.64 (0.53–0.79)***	0.73 (0.57–0.93)*	0.57 (0.39–0.82)**	0.35 (0.19–0.64)***	0.51 (0.29–0.89)*	1.77 (0.61–5.17)
CCI	0.96 (0.84–1.10)	1.04 (0.93–1.16)	0.92 (0.76–1.12)	1.08 (0.88–1.32)	1.02 (0.74–1.40)	1.16 (0.84–1.59)	0.73 (0.30–1.79)

Notes: ^aNon-PSP cohort was the reference. *P<0.05, ** P<0.01, *** P<0.001.

Abbreviations: ADA, adalimumab; AS, ankylosing spondylitis; CCI, Charlson Comorbidity Index; CI, confidence interval; HS, hidradenitis suppurativa; IBD, inflammatory bowel disease; OR, odds ratio; PBM, pharmacy benefit manager; PsA, psoriatic arthritis; PsO, psoriasis; PSP, patient support program; RA, rheumatoid arthritis; Ref, reference; SP, specialty pharmacy; TPA, third party administrator; UV, uveitis.