Why HIV Medication Adherence Should Matter to Payers
Improving adherence to HIV-1
antiretroviral therapy (ART) may help
LET’S LOOK AT THE FACTS
Poor adherence may
with the impact ranging from
$25,000 to $29,000
in total unadjusted per-patient-per-year (PPPY) costs*,1,2
*Costs represent inpatient, outpatient, and pharmacy costs based on medication possession rate of <90% in patients with HIV, adjusted to 2021 dollars.
MULTIPLE FACTORS AFFECT ADHERENCE AND VIRAL SUPPRESSION, WHICH MAY RESULT IN COMPLEX AND EXPENSIVE ART REGIMENS3
Improved adherence to ART
may result in better HIV control and
significant cost savings.3,4
In a Magellan retrospective claims study, patients with HIV who were on an ART medication for at least 3 years and experienced suboptimal adherence (PDC <95%) were more likely to incur greater annual medical costs, excluding pharmacy costs, compared with patients with high adherence (PDC ≥95%) ($8,224 vs $3,097; P=0.0007).*,4
*A retrospective cohort design of members living with HIV (N=2,030) was implemented using data from Magellan Health, Inc, a medical and pharmacy administrative claims database, and from multiple region health plans (Medicaid and commercial) in the United States between January 1, 2007, and June 30, 2016. Each patient was categorized on the basis of ART regimen pill burden. In the healthcare cost analyses, commercially insured patients were further divided into 2 cohorts on the basis of length of available follow-up data (<3 or ≥3 years). ART adherence and healthcare costs and utilization were assessed annually following the index date. Adherence was measured using proportion of days covered (PDC). Medical costs included inpatient, outpatient, laboratory, emergency department, and other medical costs.
Given the complexity of care and the importance of high adherence to achieving and maintaining viral suppression,
HCPs need access to a variety of ART options.
Open access to all ART regimens is important.
Help providers offer HIV patients the tailored care they need.
1. Cooke CE, Lee HY, Xing S. Adherence to antiretroviral therapy in managed care members in the United States: a retrospective claims analysis. J Manag Care Pharm. 2014;20(1):86-92. doi: 10.18533/jmcp.2014.20.1.86
2. Barnett PG, Chow A, Joyce VR, et al. Determinants of the cost of health services used by veterans with HIV. Med Care. 2011;49(9):848-856. dol: 10.1097/MLR.0b013e31821b34c0
3. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. US Department of Health and Human Services. Updated February 24, 2021. Accessed May 25, 2021.
4. Kangethe A, Polson M, Lord TC, Evangelatos T, Oglesby A. Real-world health plan data analysis: key trends in medication adherence and overall costs in patients with HIV. J Manag Care Spec Pharm. 2019;25(1):88-93. dol: 10.18553/jmcp.2019.25.1.088