Patient Access to Chronic Medications During the COVID-19 Pandemic: Evidence from a Comprehensive Dataset of US Insurance Claims

Objective: Patient access and adherence to chronic medications is critical. We evaluated whether disruptions related to COVID-19 affected new and existing patients’ access to pharmacological therapies without interruption.Design: We performed a retrospective analysis on a dataset of 9.4 billion US prescription drug claims from 252 million patients (about 93% of prescriptions dispensed) from May, 2019 through August, 2020. Using fixed effect (conditional likelihood) linear models, we evaluate continuity of care, how many days of supply patients received, and the likelihood of discontinuing therapy for drugs from classes with significant population health impacts.Results: More prescriptions were filled in March 2020 than in any prior month, followed by a significant drop in dispensing. Compared to the pre-COVIDera, a patient’s likelihood of discontinuing some medications increased after the spread of COVID: norgestrel-ethinyl estradiol (hormonal contraceptive) increased 0.62% (95% CI: 0.59% to 0.65%, p<0.001); dexmethylphenidate HCL (ADHD) increased 2.84% (95% CI: 2.79% to 2.89%, p<0.001); escitalopram oxalate (SSRI) increased 0.57% (95% CI: 0.561% to 0.578%, p<0.001); and haloperidol (antipsychotic) increased 1.49% (95% CI: 1.41% to 1.57%, p<0.001). In contrast, the likelihood of discontinuing tacrolimus (immunosuppressant) decreased 0.15% (95% CI: 0.12% to 0.19%, p<0.001). The likelihood of discontinuing buprenorphine/naloxone (opioid addiction therapy) decreased 0.59% (95% CI: 0.55% to 0.62% decrease, p<0.001). We also observe a notable decline in the count of new patients accessing these therapies.Conclusions and Impact: Most US patients were able to access chronic medications during the early months of COVID-19, but still were more likely to discontinue their therapies. Further, fewer than normal new patients started taking crucial medications. Providers would do well to inquire about adherence and provide prompt, nonjudgmental, re-initiation of medications. From a policy perspective, opioid management programs seem to demonstrate a robust ability to manage existing patients in spite of disruption.