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Abstract: TH-PO504

Disparities in Medication Fill Duration in Pediatric Hypertension

Session Information

  • Pediatric Nephrology - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Mclaughlin, Meghan M., University of Rochester, Rochester, New York, United States
  • Gleber, Conrad D., University of Rochester, Rochester, New York, United States
  • Lande, Marc, University of Rochester, Rochester, New York, United States
Background

Medication nonadherence is a barrier to blood pressure control. The CDC recommends prescribing 90-day fills for maintenance medications yet antihypertensives are often dispensed as 30-day fills due to insurance limits. This increases the burden of pharmacy visits, a contributor to nonadherence. We observed how often antihypertensives are dispensed as a 30-day supply despite a prescription for longer duration and the impact of 30-day vs 90-day fills on adherence.

Methods

This retrospective cohort study included patients with hypertension (HTN) seen in our Pediatric Nephrology Clinic over a 3 year period. For each patient, antihypertensive medication days prescribed was compared to days dispensed using pharmacy refill and insurance claim data. Proportion of days covered (PDC) was calculated to estimate medication adherence.

Results

A total of 449 patients (61% primary HTN, 39% secondary HTN) had 4,492 prescription orders and 8,800 dispenses over the 3-year period. While 36% of prescriptions were ordered for ≥90 days only 12% were dispensed for ≥90 days and 70% of patients had at least one prescription for ≥90 days but only 37% of patients had at least one dispense for ≥90 days. In addition, 35% of patients had a fill discrepancy (prescribed but never received a 90-day fill). There was no difference in likelihood of being prescribed a 90-day fill by insurance type (public vs private, OR = 0.82, p = 0.35) but patients with public insurance were less likely to be dispensed a 90-day fill (OR = 0.126, p <0.001) and more likely to have a fill discrepancy (OR = 6.02, p <0.001). Patients who received at least one 90-day fill had better adherence rates (median PDC, 77.5% vs 58.1%, p <0.001).

Conclusion

Longer fill duration is associated with better adherence with antihypertensive medication in pediatric patients. However, patients are often dispensed only 30-day fills despite a 90-day prescription. Patients with public insurance are markedly less likely to be dispensed 90-day fills, a modifiable barrier to improving adherence in disadvantaged youth.