Objective: To describe patient demographic and medication utilization patterns within a state Medicaid program for patients diagnosed with Parkinson’s disease (PD).

Background: Little is known regarding medication treatment patterns within the Medicaid PD population. Assessing and identifying demographic and medication use patterns forms the foundation for understanding how treatment decisions ultimately impact disease progression and the outcomes that result.

Method: We conducted an observational study of secondary medical and prescription utilization data derived from Texas Medicaid administrative healthcare claims for patients aged 18 to 63 years with a PD diagnosis between 9/1/12 and 8/31/15, and utilizing at least one or a combination of the following PD medication classes: levodopa, dopamine agonists (DA), monoamine oxidase-b (MAOB) inhibitors, or catechol-o-methyl transferase (COMT) inhibitors at any time following the diagnosis. Patients were characterized as newly or previously diagnosed with PD and were followed for 12 months post-index. Medication adherence was calculated using the proportion of days covered (PDC) during the post-index period beginning with the date of first prescription. We measured rates of persistence using a 45-day gap in therapy to define discontinuation of medication.

Results: A total of 691 patients diagnosed with PD were included in the study sample with an average age of 55.2 years, 53.1% were female, and 42% were characterized as newly diagnosed. A total of 81.9% of patients utilized levodopa in mono- or combination therapy, followed by DA (43%), MAOB (8.7%), and COMT (5%). Combined levodopa/DA use was seen in 23.9% of patients. Overall, newly diagnosed patients utilized levodopa over DA as the initial treatment by a 2:1 ratio and averaged 41.6 days to start levodopa and 33.6 days to start DA. Patients <55 and >55 years utilized levodopa first over DA by a 1.56:1 and 2.28:1 ratio, respectively. Adherence rates in the 12-month post-index period for all patients using levodopa (no DA) were 65.3%, 64.8% for DA (no levodopa), and 60.4% for those using combination levodopa/DA. Within those same cohorts, persistency rates for levodopa patients were 52.6%, 51.2% for DA, and 47.3% for levodopa/DA.

Conclusion: Our sample of Medicaid patients showed predominant use of levodopa, followed by DA, with relatively low rates of medication adherence and persistence across both classes of PD therapy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-analysis-of-parkinsons-disease-medication-treatment-patterns-among-medicaid-patients/