LAUSR

BackgroundData on primary nonadherence remains sparse, due to a lack of data resources that combine information on medication prescribing and dispensing. In addition, previous work on primary nonadherence has used follow-up periods ranging from 30 days up to 18 months, making results difficult to compare.ObjectiveTo evaluate the prevalence and predictors of primary nonadherence by measuring time until filling in a cohort of elderly patients.DesignRetrospective cohort study of new prescription episodes.PatientsData comes from a linked database of electronic health records and claims for patients aged ≥ 65 years enrolled in Medicare Parts A, B, and D during 2007–2014. We identified patients receiving a new prescription for a chronic disease medication with continuous Medicare enrollment for 180 days prior to the index prescription order and no fills or orders for the medication during this period.Main MeasuresTime until filling of the index prescription for up to 1 year.Key ResultsIn 32,586 new medication orders, the majority (75%; 95% confidence interval [CI] 74–75%) of new prescriptions were filled within 7 days, 81% (81–82%) were filled within 30 days, and 91% (91–92%) were filled within 1 year. The rate and timing of dispensing were similar across therapeutic areas. Timing of initial filling within 7 days or within 30 days could be predicted with moderate accuracy (C-statistics = 0.70–0.74). Patients with > 5 current medications on hand at the time of the index prescription and average out-of-pocket medication costs < $5 filled 89% of prescriptions within 7 days. Patients with no current medications and out-of-pocket costs > $50 filled only 25% of prescriptions within 7 days.ConclusionsNearly 20% of patients do not fill a new chronic disease prescription within 30 days. Patients with fewer recent fills and higher out-of-pocket costs are at higher risk of primary nonadherence.