Benefit Plan Design Improvements Can Enhance Statin Adherence in Minorities

Pharmacists can take steps to improve adherence to statins among patients in minority communities who are more likely to be non adherent.

A recent study published in the Journal of Racial and Ethnic Health Disparities closely examined statin medication adherence in minority communities to determine factors that contribute to low adherence and figure out how pharmacists can improve it. The study, which was conducted in collaboration between Walgreens and the University of Chicago, found that pharmacist interventions and benefit-plan designs with low copays can help improve statin medication adherence among patients in predominantly African-American and Hispanic communities.

The researchers studied statin adherence rates among more than 300,000 patients, focusing on those filling new prescriptions for statin medications at Walgreens pharmacies in predominantly African-American and Hispanic communities and comparing them with those filling the same prescriptions at Walgreens in mostly Caucasian neighborhoods. Patients living in communities with at least 50% African-American residency tended to have lower co-pays, use more Medicaid coverage, have lower incomes, be less educated, and be more likely to reside in an urban area. A similar pattern was seen among patients in majority Hispanic communities.

The analyses of patients’ poor adherence in minority communities were adjusted to fit the complex associations of race and ethnicity with education and poverty, adjusting for patient-level factors including co-pay amount, payer, social disadvantage, income, and education levels. Despite these adjustments, the results demonstrated that patients in African-American and Hispanic communities had 2 to 3 weeks less statin therapy over a 1-year time period—a significant difference.

The study authors suggested that local pharmacies can help curb high levels of statin medication nonadherence in minority communities in conjunction with policy and benefit design interventions, such as co-pay reduction and patient-level educational support. For instance, community pharmacists can incorporate brief face-to-face counseling sessions with patients to improve their understanding of treatment and the benefits of medication adherence. Other variables associated with improved adherence included a co-pay below $10, the use of 90-day refills, and a health plan other than Medicaid.

“Our study demonstrates that lower adherence in largely minority neighborhoods is a significant challenge, and suggests that community pharmacies can play a role in helping to address it,” stated Michael Taitel, PhD, study co-author and senior director of health analytics, research, and reporting for Walgreens, in a press release. “…Adherence to medications for chronic conditions such as high cholesterol is critical to the prevention of unnecessary hospitalizations and better heart health outcomes for patients.”

Previous research found that lower adherence to cardiovascular medications among African-American and Hispanic patients is linked to a persistent 7-year lower overall life expectancy compared with Caucasian patients. Another study uncovered that patients with acute coronary syndrome often discontinue statins due to perceived drug-related symptoms, and the most common reason is statin-associated muscle symptoms. Notably, statin nonadherence was associated with elevated 5-year cardiovascular and all-cause mortality risk.

By gleaning a better understanding of the factors associated with medication nonadherence, pharmacists can find ways to improve medication adherence among their patients.