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State and Regional Variation in Prescription- and Payment-Related Promoters of Adherence to Blood Pressure Medication

ORIGINAL RESEARCH — Volume 17 — September 24, 2020

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Figure 1. Concentration ratios of adherence promotion factors related to prescriptions among the largest market segments, by US Census region, 2017. Data source: 2017 Symphony Health Integrated Dataverse (15). Abbreviations: NP, nurse practitioner; PA, physician assistant; PCP, primary care physician.

Concentration ratios of adherence promotion factors related to prescriptions among the largest market segments, by US Census region, 2017. Data source: 2017 Symphony Health Integrated Dataverse (15). Abbreviations: NP, nurse practitioner; PA, physician assistant; PCP, primary care physician.
Promoter Age Group, Years Market Segment Northeast Midwest South West
Fixed-dose combination fills 18-64 PCP/Commercial 1.13 1.30 1.49 1.09
NP and PA/Commercial 0.89 1.06 1.34 0.91
PCP/Medicaid 0.78 0.81 0.86 0.51
Other Combinations 0.60 0.78 0.65 0.82
≥65 PCP/Medicare 0.96 1.06 1.22 0.92
PCP/Commercial 1.25 1.38 1.56 1.24
Cardiologist/Medicare 0.51 0.41 0.58 0.48
Other Combinations 0.81 1.00 0.52 0.75
Fills acquired via mail order 18-64 PCP/Commercial 2.09 1.79 1.06 1.19
NP and PA/Commercial 1.62 1.28 0.77 0.89
PCP/Medicaid 0.03 0.05 0.15 0.04
Other Combinations 0.92 0.94 0.81 1.00
≥65 PCP/Medicare 0.45 1.01 0.94 0.69
PCP/Commercial 2.57 2.74 1.62 1.73
Cardiologist/Medicare 0.46 0.83 0.74 0.62
Other Combinations 0.69 0.75 0.53 0.66
Days’ supply per fill, mean 18-64 PCP/Commercial 1.12 1.11 1.05 0.97
NP and PA/Commercial 1.05 1.04 0.97 0.92
PCP/Medicaid 0.77 0.77 0.76 0.84
Other Combinations 0.99 0.94 1.00 0.97
≥65 PCP/Medicare 0.99 1.07 1.02 1.06
PCP/Commercial 1.07 1.08 0.99 0.97
Cardiologist/Medicare 1.05 1.03 0.97 1.04
Other Combinations 0.99 0.92 0.95 0.94

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Figure 2. Concentration ratios of adherence promotion factors related to payments among the largest market segments, by US Census region, 2017. Data source: 2017 Symphony Health Integrated Dataverse (15). Abbreviations: NP, nurse practitioner; PA, physician assistant; PCP, primary care physician.

Concentration ratios of adherence promotion factors related to payments among the largest market segments, by US Census region, 2017. Data source: 2017 Symphony Health Integrated Dataverse (15). Abbreviations: NP, nurse practitioner; PA, physician assistant; PCP, primary care physician.
Promoter Age Group, Years Market Segment Northeast Midwest South West
Fills for generic formulations 18-64 PCP/Commercial 0.99 1.00 1.00 1.00
NP and PA/Commercial 1.00 1.00 1.00 1.01
PCP/Medicaid 1.02 1.02 1.01 1.02
Other Combinations 0.99 0.99 1.00 1.00
≥65 PCP/Medicare 1.01 1.01 1.01 1.01
PCP/Commercial 0.98 0.99 0.99 1.00
Cardiologist/Medicare 0.98 0.99 0.99 0.98
Other Combinations 1.00 1.00 1.00 1.00
Fills with lower or no copayment 18-64 PCP/Commercial 0.88 0.84 0.86 0.91
NP and PA/Commercial 0.92 0.88 0.91 0.95
PCP/Medicaid 1.45 1.49 1.48 1.49
Other Combinations 1.07 0.97 1.07 0.91
≥65 PCP/Medicare 1.08 1.06 1.11 1.12
PCP/Commercial 0.79 0.74 0.81 0.83
Cardiologist/Medicare 0.96 1.02 1.04 1.03
Other Combinations 1.03 0.97 1.11 1.02
Out-of-pocket spending per therapy year 18-64 PCP/Commercial 1.01 1.04 1.22 1.07
NP and PA/Commercial 1.00 1.06 1.20 1.06
PCP/Medicaid 0.23 0.16 0.22 0.10
Other Combinations 0.93 0.92 1.07 0.91
≥65 PCP/Medicare 0.86 0.81 0.78 0.73
PCP/Commercial 1.14 1.18 1.29 1.18
Cardiologist/Medicare 1.09 0.97 1.03 1.01
Other Combinations 1.16 1.20 1.23 1.12

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