Failure to refill essential prescription medications for asthma among pediatric Medicaid beneficiaries with persistent asthma

Varun Vaidya,¹ Renuka Gupte,² Rajesh Balkrishnan<sup>3

1</sup>Pharmacy Health Care Administration, Department of Pharmacy Practice, University of Toledo College of Pharmacy, Toledo, OH, USA; ²Private Practice, Sylvania, OH, USA; ³Department of Clinical, Social and Administrative Sciences, Pharmacy, The University of Michigan, Ann Arbor, MI, USA

Abstract: The problem of patients not taking medications as prescribed, also known as "lack of medication adherence," is widely discussed as an issue related to suboptimal outcomes and excess health care expenditure. Although medication adherence is defined as patients not taking medications as prescribed, there are two elements to it: first, those who fail to follow the medication regimen by skipping a dose or not following the instructions, resulting in poor adherence with prescribed medicines; and, second, the patient who does not take the medication at all or stops after the initial fill. The existing literature contains a lot of studies on the first element, but very little is known about those who stop taking their medication after the initial fill or do not take it at all. In this study, our focus is on identifying patients who fail to refill a prescription for essential medicines, such as asthma-controlling drugs. Using Medicaid claims datasets, this study analyzed a pediatric population diagnosed with persistent asthma that discontinued an essential controlling medication after the initial fill. We found that more than half of this population did not continue their medication after the first fill. While there might be many reasons behind the failure to refill such medications, our data indicate that race/ethnicity, comorbid illness, and type of Medicaid plan are potentially associated with such behavior. Future research is warranted to understand this issue further and identify specific factors causing such behavior, such that strategies may be formulated by which poor adherence can be minimized.

Keywords: medication adherence, asthma, Medicaid, controller medication, prescription refill