How do formulary changes and benefit design features impact treatment stability for patients with serious chronic conditions? Our research examines the real-world implications for patients with atrial fibrillation (AFib).
Patients living with non-valvular atrial fibrillation (NVAF), which is the most common type of AFib, rely on long-term anticoagulation therapy to prevent stroke and other complications. Yet, evidence suggests that non-medical factors, such as cost and insurance coverage, can significantly disrupt care.
In a 2019 large claims-based analysis of over 46,000 U.S. adults with NVAF, researchers found that 18.0% of patients switched or discontinued their direct oral anticoagulant (DOAC) in the first quarter of the year, which was more than double the 8.8% average in subsequent quarters of the year. This 9.2% differential can be attributed to non-medical switching or discontinuation (NMSD), likely triggered by formulary and cost-sharing deductibles that reset in Q1.
Patients who experienced NMSD in Q1 were also more likely to remain untreated in the following quarter (77.0%) compared to those who discontinued later in the year, raising concerns about gaps in therapy. The study also found that socioeconomic disparities, such as younger age, Black race, and lower income, were associated with a significantly higher risk of switching or discontinuation in Q1, which aligns with previous findings of disparities in DOAC treatment and persistence patterns in these populations.
These findings suggest that formulary design and benefit structures may inadvertently compromise treatment continuity and widen health disparities. As policymakers weigh changes to insurance design, this research underscores the need to account for the potential long-term clinical impact of non-medical switching.
This research was funded by Johnson & Johnson and conducted in collaboration with researchers at the Analysis Group. For full details on the study design, methods and limitations, see: Ingham M., et al. Non-Medical switching or discontinuation patterns among patients with non-valvular atrial fibrillation treated with direct oral anticoagulants in the United States: A claims-based analysis. Published Online September 2, 2024. Journal of Market Access & Health Policy, 12(3), 252–263. doi.org/10.3390/jmahp12030020
© Johnson & Johnson and its affiliates 2025 12/25 cp-554322v1