Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan
Commonwealth Medicine, Clinical Pharmacy Services; Commonwealth Medicine, Center for Health Policy and Research
Health Economics | Health Law and Policy | Health Policy | Health Services Administration | Health Services Research | Maternal and Child Health | Pharmacy and Pharmaceutical Sciences | Women's Health
OBJECTIVES: Progesterone (hydroxyprogesterone caproate injection and vaginal progesterone) has been shown to reduce preterm birth (PTB) rates by a third among pregnant women at high risk. The purpose of this analysis is to report birth outcomes and medication adherence among Massachusetts Medicaid (MassHealth) members receiving progesterone, evaluate the association between member characteristics and birth outcomes and medication adherence, and compare cost of care with a prior preterm pregnancy.
METHODS: This retrospective cohort study used medical claims, pharmacy claims, and prior authorization (PA) request data for MassHealth members who had a PA submitted for progesterone between January 1, 2011, and March 31, 2015. Members were excluded due to breaks in coverage, progesterone was not indicated for prevention of PTB, and if current gestational week or date of delivery was unavailable.
MAIN RESULTS: A total of 418 members were screened for inclusion of whom 190 met criteria and 169 filled progesterone. Mean age was 29.2 years (SD = 5.23), and clinical comorbidities were identified in 90.5% of members. Consistent with clinical trials on progesterone effectiveness, 62.1% of members had a term delivery (37 wks of gestation). Among members with prior gestational age at delivery available, the average difference in gestational age between pregnancies was 8.25 weeks (SD = 6.11). In addition, 66.3% of members were adherent to progesterone based on proportion of days covered (PDC) of 0.8 or higher. The overall mean PDC was 0.79 (SD = 0.26).
CONCLUSION: Despite similar birth outcomes in clinical trials and national trends, medication adherence is low in this state Medicaid program. Therefore, members may benefit from adherence support.
adherence, birth outcomes, hydroxyprogesterone caproate, preterm birth
DOI of Published Version
Pharmacotherapy. 2017 Oct;37(10):1328-1334. doi: 10.1002/phar.2020. Epub 2017 Sep 28. Link to article on publisher's site
Hydery T, Price MK, Greenwood BC, Takeshita M, Kunte PS, Mauro RP, Lenz KJ, Jeffrey PL. (2017). Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan. Commonwealth Medicine Publications. https://doi.org/10.1002/phar.2020. Retrieved from https://escholarship.umassmed.edu/commed_pubs/86