Study: Receipt of Medications Relatively Stable During COVID-19 Pandemic

Receipt of medications for chronic conditions was relatively stable in the first 2 years of the COVID-19 pandemic across racial and ethnic groups, according to a study published in JAMA Network Open. Receipt of medications for chronic conditions was also relatively stable for community-dwelling patients with dementia for the same time period, according to the study.

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Inpatient and ambulatory care is known to have declined during the first 2 years of the COVID-19 pandemic; however, little is known about prescription drug receipt during this period, the study authors noted. Considering the importance of prescription drugs in effective management of chronic conditions, researchers sought to explore an association between the pandemic’s disruption of health care and pharmacotherapy for chronic conditions.

Researchers hypothesized that disruption of in-person care during the pandemic would be associated with a decline in prescription receipt as a complement to in-person visits. Thus, they conducted a cohort study to investigate whether receipt of medications was maintained during the first 2 years of the COVID-19 pandemic among older people with chronic diseases. The study focused particularly on Asian, Black, and Hispanic populations as well as people with dementia—populations that faced pandemic-related care disruptions.

The study included a 100% sample of US Medicare fee-for-service administrative data from 2019 to 2021 for community-dwelling beneficiaries aged 65 years or older. Researchers compared population-based prescription fill rates for 2020 and 2021 to 2019, considered prepandemic. Data were analyzed from July 2022 to March 2023.

The mean monthly cohort included 18,113,000 beneficiaries (mean [SD] age, 74.5 [7.4] years; 10,520,000 females [58.1%]; 587,000 Asian [3.2%], 1,069,000 Black [5.9%], 905,000 Hispanic [5.0%], and 14,929,000 White [82.4%]). Additionally, 1,970,000 individuals (10.9%) were diagnosed with dementia. Across 5 drug classifications, the results showed mean fill rates increased by 2.07% (95% CI, 2.01% to 2.12%) in 2020 and decreased by 2.61% (95% CI, −2.67% to −2.56%) in 2021 compared with 2019.

Further, fill rates decreased by less than the mean overall decrease for Black enrollees (−1.42%; 95% CI, −1.64% to −1.20%), Asian enrollees (−1.05%; 95% CI, −1.36% to −0.77%), and people diagnosed with dementia (−0.38%; 95% CI, −0.54% to −0.23%).

Although researchers found evidence of larger declines in the receipt of antidepressants for Hispanic Medicare enrollees and angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) for individuals diagnosed with Alzheimer disease-related dementia (ADRD), there were small overall mean differential changes in receipt by race, ethnicity, and ADRD diagnosis status in comparison with dramatic declines in hospitalizations and physician visits in the early phases of the pandemic.

Researchers conducted secondary analyses to measure proportion of fills before and during the pandemic, occurring as 90-day or greater supplies, given that larger supplies may be associated with a decreased risk of patients running out of medications when lockdowns or fear could limit pharmacy access.

With an increase per 100 fills of 3.98 fills (95% CI, 3.94 to 4.03 fills) overall, the proportion of fills dispensed as 90-day or greater supplies increased during the pandemic for all groups. Overall, receipt of medications for chronic conditions was relatively stable in the first 2 years of the COVID-19 pandemic overall, contrasting in-person health services.

The researchers suggest these findings were likely associated with robust prescription dispensing and delivery infrastructure in the United States and the uncoupling of prescription renewals from in-person visits.

“The stability may also reflect well-established performance metrics that have long held Part D plans accountable for medication adherence among patients with chronic illness and thus have promoted plan features and beneficiary support aimed at maintaining medication receipt,” they wrote.

Additionally, the study authors pose that the increase in 90-day or greater supplies, especially in minority populations less likely to receive such supplies prior to the pandemic, may represent a small health care delivery success for populations otherwise disproportionately negatively impacted by the pandemic.

These findings offer lessons for the next pandemic, including that investment in remote care infrastructure and effective schemes for other health care services that can be delivered safely without an in-person visit to a health care facility may be associated with reduced impact of future disruptive forces.

Reference

Morden NE, Zhou W, Obermeyer Z, Skinner J. Receipt of Medications for Chronic Disease During the First 2 Years of the COVID-19 Pandemic Among Enrollees in Fee-for-Service Medicare. JAMA Netw Open. 2023;6(5):e2313919.