Effects of Copayment on Initiation of Smoking Cessation Pharmacotherapy: An Analysis of Varenicline Reversed Claims

BackgroundSmoking cessation pharmacotherapy is a critical component of smoking cessation treatment, but most smokers use neither pharmacotherapy nor behavior counseling in attempts to quit smoking. The low rate of smoking cessation medication use is of great concern because it can negatively influence the odds of success in smoking cessation.ObjectiveThis study was conducted to analyze how copayment may influence the likelihood of initiating smoking cessation pharmacotherapy following a reversed varenicline claim.MethodsA retrospective cohort analysis was performed using pharmacy claims data from a large national pharmacy benefits management company. Reversed claims were claims first approved by the health plan and then reversed by the pharmacy. The study population included patients with over-the-counter nicotine replacement therapy coverage and a reversed varenicline claim between January 2007 and April 2008 and who were naive to varenicline before the reversed claim. A multivariate logistic regression analysis was conducted to evaluate the probability of initiating any smoking cessation pharmacotherapy (varenicline, bupropion, and prescribed or over-the-counter nicotine replacement therapy) within 183 days of the reversed claim.ResultsA total of 20,451 patients met the inclusion criteria. The mean (SD) age of patients was 47.8 (12.4) years, with 57.41% being female. The majority (87.72%) were covered in commercial managed care plans. A total of 17,028 patients (83.26%) had at least 1 smoking cessation medication filled 6 months after their reversed claim. The odds ratios for patients who had any smoking cessation medication filled and copayments of $31 to $40, $41 to $60, or >$60 were 0.68, 0.48, and 0.35, respectively (all, P < 0.001), compared with patients with copayments of $0 to $5.ConclusionsThe findings suggest that some patients might have been deterred by a high copayment (≥$31) and, ultimately, did not fill any smoking cessation treatments within 183 days of reversed varenicline claims. It is important to address this potential treatment gap to improve the effectiveness of smoking cessation therapy.