{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T08:07:33Z","timestamp":1768291653880,"version":"3.49.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,11,15]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Pharmacologic treatment for pulmonary arterial hypertension (PAH) improves exercise capacity, functional class, and hemodynamic indexes. However, monthly prescription costs often exceed $4000. We examined associations between (1) medication copayment and (2) annual household income with adherence to pulmonary vasodilator therapy among individuals with PAH.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We used administrative claims data from an insured population in the United States to identify individuals diagnosed with PAH between 2015 and 2020. All individuals had \u22651 medication claim for endothelin receptor antagonists, phosphodiesterase type\u20105 inhibitors, prostanoids or prostacyclin receptor agonists, or the soluble guanylate cyclase stimulator riociguat. We defined copayments as low, medium, or high, as determined by their distributions for each medication class. Annual household income was categorized as &lt;$40\u2009000, $40 000 to $74\u2009999, and \u2265$75\u2009000. The primary outcome was medication adherence, defined by proportion of days covered \u226580%. We studied 4025 adults (aged 65.9\u00b113.3\u2009years; 71.2% women). Compared with those with annual household income \u2265$75\u2009000, individuals in the &lt;$40\u2009000 and $40\u2009000 to $74\u2009999 categories had no significant differences in medication adherence. Compared with those with low copayments, individuals with high copayments had decreased adherence to prostanoids (odds ratio [OR], 0.36 [95% CI, 0.20\u20130.65];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and combination therapy with endothelin receptor antagonist and phosphodiesterase type\u20105 inhibitor (OR, 0.61 [95% CI, 0.38\u20130.97];\n              <jats:italic>P<\/jats:italic>\n              =0.03).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">We identified associations between copayment and adherence to prostanoids and combination therapy among individuals with PAH. Copayment may be a structural barrier to medication adherence and merits inclusion in studies examining access to pharmacotherapy among individuals with PAH.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026620","type":"journal-article","created":{"date-parts":[[2022,11,12]],"date-time":"2022-11-12T10:37:12Z","timestamp":1668249432000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Association Between Copayment and Adherence to Medications for Pulmonary Arterial Hypertension"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5819-7796","authenticated-orcid":false,"given":"Erin M.","family":"Schikowski","sequence":"first","affiliation":[{"name":"Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4212-5189","authenticated-orcid":false,"given":"Gretchen","family":"Swabe","sequence":"additional","affiliation":[{"name":"School of Medicine University of Pittsburgh Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9520-7527","authenticated-orcid":false,"given":"Stephen Y.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA"},{"name":"Vascular Medicine Institute University of Pittsburgh School of Medicine Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5075-3604","authenticated-orcid":false,"given":"Jared W.","family":"Magnani","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA"},{"name":"School of Medicine University of Pittsburgh Pittsburgh PA"},{"name":"Center for Research on Health Care, Department of Medicine University of Pittsburgh Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-018-0272-5"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0085-2016"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02043-2015"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00209914"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp022"},{"key":"e_1_3_1_7_2","first-page":"S119","article-title":"Ensuring appropriate access to pulmonary arterial hypertension therapy","volume":"25","author":"Highland KB","year":"2019","unstructured":"Highland KB, Hughes KE, Williams KJ, Kyei\u2010Baffour B, Ferguson S. 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