Patients started on less costly generic statin drugs have significantly better adherence than those started on brand name statins, as well as improved cardiovascular outcomes, according to results from a study that looked at records from more than 90,000 Medicare patients aged 65 and older (mean age 75.6, 61% female) over a 2-year period.
The study, led by Joshua J. Gagne, Pharm.D., Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and published online Sept. 15 in Annals of Internal Medicine (doi:10.7326/M13-2942), found that the average portion of days covered under prescribed statin therapy was 77% for patients started on generic lovastatin, pravastatin, or simvastatin, and 71% for patients started on name brands of these medications (P < .001). Researchers pinpointed cost as the likeliest reason for the differences in adherence; mean copay in the study was $10 for generics and $48 for brand-name drugs.
©PhotoDisk
Patients are more likely to adhere to cheaper, generic statin prescriptions than brand-name statins.
Dr. Gagne and colleagues also reported that patients on generics saw an 8% reduction in cardiovascular events (as measured by a composite outcome of hospitalization for an acute coronary syndrome, stroke, or all-cause mortality), compared with those on brand-name medications (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99).
Dr. Gagne and colleagues called the difference in cardiovascular outcomes “commensurate with the expected effect” based on differences in adherence, while noting that theirs was the first study to demonstrate differences in health outcomes related to the dispensing of generic or brand-name statins. Most patients in the study (n = 83,731) were started on generics. Generic drug recipients were more likely to be women (62% vs. 54%), and brand-name statin recipients were more likely to be white (66% vs. 48%).
“In the setting of tiered copayments in typical pharmacy benefit designs, initiating a generic versus a brand-name statin seems to be associated with lower out-of-pocket costs, improved adherence to therapy, and improved clinical outcomes,” the researchers concluded (Ann. Int. Med. 2014;161:400-7. [doi:10.7326/M13-2942]).
Dr. Gagne and colleagues noted among the limitations of their study its nonrandomized design, the use of only three statins, and the fact that they could not determine who decided whether patients initiated a generic or brand-name drug, noting that many states require pharmacists to dispense generics unless a prescriber or patient requests otherwise. The results may not apply to patients with types of insurance other than Medicare, they noted.
Teva pharmaceuticals, a manufacturer of generic medications, sponsored the study; Dr. Gagne and a coauthor, Niteesh K. Choudhry, M.D., Ph.D., disclosed grant support from Teva, while three coauthors disclosed being employees of CVS Caremark, a major pharmacy benefits administrator.