Year of Publication

2014

College

Martin School of Public Policy and Administration

Degree Name

Master of Public Administration

Executive Summary

Uninsured and underinsured people living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) are able to utilize federally funded AIDS Drug Assistance Programs (ADAPs) to cover the price of their HIV-related medications. In Kentucky, this program also provides support services through social workers, a dedicated pharmacist, and medications by mail order. With the Affordable Care Act, many patients previously covered by the Kentucky AIDS Drug Assistance Program (KADAP) will be newly eligible for Medicaid and will no longer receive services through KADAP. There is concern that people in this situation will be at a disadvantage without these services and, in turn, be less adherent to their medications. People living with HIV/AIDS should regularly take ≥95% of their medications in order to prevent medication resistance and disease-related morbidity and mortality.

The purpose of this study is to determine the average medication adherence of patients in KADAP and Kentucky Medicaid, evaluate whether people enrolled in Medicaid have significantly lower adherence compared to KADAP, and determine if any demographic variables are associated with medication nonadherence in either program through multivariate regression. With this information, recommendations will be made regarding what can be done from programmatic and policy standpoints to increase medication adherence in this population.

Pharmacy claims and demographic data were collected from the Kentucky Clinic Pharmacy and the Bluegrass Care Clinic at the University of Kentucky for all of 2011. Medication adherence was calculated using the medication possession ratio (MPR), which calculates the percentage of time the patient has their medications on hand each month based on pharmacy claims data. The average MPR for KADAP patients is 84.7% (n=2,2024; range: 14.9%-100%) and the average MPR for Medicaid patients is 77.3% (n=55; range: 16.4%-100%). When KADAP and Medicaid data were combined, 3 variables were significantly associated with MPR in multivariate regression: age (coef: 0.123, p

Younger, black KADAP patients tend to have lower MPRs and Kentucky Medicaid patients have significantly lower MPRs than KADAP patients. In order to increase adherence, the policy regarding Medicaid and KADAP co-enrollment should be changed to allow newly eligible Medicaid patients to continue using KADAP’s services without financial need. Additionally, pharmacy call lists could be made, with priority on younger, black KADAP patients, for refill reminders and to open dialogue between the patient and the pharmacist regarding medication concerns.

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