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AMBULATORY CARE

Impact of Obtaining Medications from Pharmaceutical Company Assistance Programs on Therapeutic Goals

Assistant Professor, Department of Pharmacy Practice and Division of Physician Assistant Studies, Shenandoah University, Winchester, VA

Dawn E Havrda, PharmD BCPS

Associate Professor, Department of Pharmacy Practice, Shenandoah University

Reprints: Dr. Trompeter, Department of Pharmacy Practice, Shenandoah University, MOB II, 190 Campus Blvd., Suite 430, Winchester, VA 22601, fax 540/542-6210, jtrompet{at}su.edu

BACKGROUND: Limited data exist regarding whether improved access to medications for indigent persons through pharmaceutical company assistance programs (PCAPs) leads to attainment of therapeutic goals.

OBJECTIVE: To evaluate the impact of obtaining medications through PCAPs with pharmacist assistance versus prescription insurance on the likelihood of achieving therapeutic goals.

METHODS: A retrospective chart review was conducted in a private family practice clinic. Individuals prescribed one or more drugs for the treatment of hypertension, diabetes, or dyslipidemia and receiving medication through a PCAP or prescription insurance were included. Eligible records were reviewed for pertinent laboratory and medication information and to assess achievement of hypertension, diabetic, and dyslipidemia goals.

RESULTS: A total of 458 persons were eligible for inclusion: 250 with prescription insurance and 208 using a PCAP. The PCAP group was older, with more females and multiple disease states. There was no significant difference between the groups in reaching hypertension goals; the goals were not predicted by PCAP, presence of diabetes, or class of drug. More PCAP individuals (67.1%) achieved hemoglobin A1C values less than 7% compared with patients in the prescription insurance group (39.6%; p = 0.002). The PCAP group had lower low-density lipoprotein cholesterol (LDL-C) values (95.8 ± 28.0 mg/dL; mean ± SD) and higher high-density lipoprotein cholesterol (HDL-C) values (40.8 ± 12.1 mg/dL) compared with the prescription insurance group (111.8 ± 37.5 mg/dL; p < 0.001 and 33.7 ± 13.6 mg/dL; p = 0.011, respectively). Achieving LDL-C goals were significant only for a goal less than 130 mg/dL and less than 160 mg/dL (p = 0.007); diabetes patients were less likely to achieve LDL-C goals compared with those without diabetes in both groups. Enrollment in PCAP was a predictor in reaching diabetic and some dyslipidemia therapeutic goals.

CONCLUSIONS: Individuals without prescription insurance and receiving pharmacist and PCAP assistance in obtaining medications were more likely to reach diabetic goals and have better cholesterol values compared with persons with prescription insurance. The presence of prescription insurance alone does not guarantee reaching therapeutic goals; pharmacist involvement with PCAP and obtaining drugs enhances the likelihood of persons achieving therapeutic goals.

Key Words: diabetes mellitus, dyslipidemia, hypertension, indigent population, insurance, medication assistance, pharmacy services

Published Online, February 24, 2009. www.theannals.com, DOI 10.1345/aph.1L420