Purpose: Impact of nonadherence among transplant recipients has been well documented as a significant contributor of allograft failure. Medicare covers immunosuppressive medications for eligible patients but no studies have examined the effect of changes in Medicare B coverage on transplant recipients' adherence. The objective of this study was to compare medication adherence for transplant recipients whose immunosuppressants were covered by Medicare Part B insurance over a one year period to those whose coverage changed during that period.

Methods: Thisretrospective,observationalcohortstudyused administrative claims data fromalarge,U.S.pharmacy chain.Medicationadherencewasmeasuredbyproportionofdays covered(PDC).The study sampleincludedtransplantrecipientsaged18+whohad2+pharmacyclaims fortacrolimus at least 150 days apart followed for a 12-month time period between 2014 and 2015.Logistic regression was used to estimate the differencein medication adherencebetweentheintervention and controlgroups and to adjust for covariables (i.e., age, gender, presence of comorbid conditions, annual copay, use of specialized pharmacies, and generic use). The dependent variable, medication adherence, was measured as PDC ≥80% over a 12-month period.

Results: The study cohort included 951interventionand9,760 controlpatients. After adjusting for covariables, transplant recipients whose medications were covered by Medicare Part B for the full one year period were 1.35 times more likely to be adherent than those whose medication was not covered by Medicare Part B for the full one year period (95% CI [1.17-1.55]; p<.001). Other important predictors of adherence included use of brand medications (OR=1.18, [1.06, 1.33]; p <.001) and transplant specialized pharmacies (OR=1.33, [1.19, 1.45]; p <.001).

Conclusion: The results showed that transplant recipients whose immunosuppressants were covered by Medicare B over a one year period were more adherent than those who were not covered by Medicare B for the entire period. Limitations of the study include its observational design and a reliance on administrative data from one pharmacy chain. This finding has policy implications and should be part of further discussions at expanding Medicare coverage for transplant recipients who have gaps in medication compliance due to insurance and affordability.

CITATION INFORMATION: Boghani S, Kirkham H, Berry Z, Kang M. Medication Adherence and Medicare B Coverage Among Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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