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PLoS One. 2019 Jun 6;14(6):e0217798. doi: 10.1371/journal.pone.0217798. eCollection 2019.

High rates of medication adherence in patients with pulmonary arterial hypertension: An integrated specialty pharmacy approach.

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Vanderbilt Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Huntsville Hospital, Department of Pharmacy, Huntsville, Alabama, United States of America.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.


Phosphodiesterase-5 inhibitors (PDE-5I) have demonstrated improvement in disease symptoms and quality of life for patients with pulmonary arterial hypertension (PAH). Despite these benefits, reported adherence to PDE-5I therapy is sub-optimal. Clinical pharmacists at an integrated practice site are in a unique position to mitigate barriers related to PAH therapy including medication adherence and costs. The primary objective of this study was to assess medication adherence to PDE-5I therapy within an integrated care model at an academic institution. The secondary objective was to assess the impact of out-of-pocket (OOP) cost, frequency of dosing, adverse events (AE) and PAH-related hospitalizations on medication adherence. We performed a retrospective cohort analysis of adult patients with PAH who were prescribed PDE-5I therapy by the center's outpatient pulmonary clinic and who received medication management through the center's specialty pharmacy. We defined optimal medication adherence as proportion of days covered (PDC) ≥ 80%. Clinical data including AEs and PAH-related hospitalizations were extracted from the electronic medical record, and financial data from pharmacy claims. Of the 131 patients meeting inclusion criteria, 94% achieved optimal adherence of ≥ 80% PDC. In this study population, 47% of patients experienced an AE and 27% had at least one hospitalization. The median monthly OOP cost was $0.62. Patients with PDC<80% were more likely to report an AE compared to patients with PDC≥ 80% (p = 0.002). Hospitalization, OOP cost, and frequency of dosing were not associated with adherence in this cohort. Patients receiving PDE-5I therapy through an integrated model achieved high adherence rates and low OOP costs.

Conflict of interest statement

NBS receives support from an unrestricted grant from AbbVie Inc. ARH has served as a consultant to Actelion, Bayer, Complexa and United Therapeutics. She has had grant funding from the NIH and CMREF. ADZ receives research support from Gilead Sciences, Inc. and Sanofi Inc. However, this study did not receive any funding and the noted author disclosures do not impact this study. These financial disclosures do not alter our adherence to PLOS ONE policies on sharing data and materials.

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