You wrote the prescription, but will it get fi Nearly 16% of antihypertensive prescriptions in this study went unfi lled. Managed care denials played a big part, but a third of the time patients didn't pick up medications. E-prescribing feedback could help reverse these rates.

Purpose Despite numerous studies on adherence, there is little research on the fi ll rate of antihypertensive prescriptions. Our study took advantage of the recent increase in electronic prescribing (e-prescribing) and used data from e-prescribing physicians to determine the fi ll failure rate of antihypertensive prescriptions and to assess which factors predict fi rst-fi ll failure. Methods This retrospective study reviewed claims from a Mid-Atlantic managed care organization (MCO). We included adult members with continuous medical and pharmacy coverage who were prescribed an antihypertensive in 2008 by an e-prescribing physician. First-fi ll failure occurred when the patient did not obtain the antihypertensive medication due to either a denial by the MCO or reversal by the dispensing pharmacist. (Pharmacists reverse claims when a patient fails to pick up a medication.) Multivariate regression analysis determined the clinical and demographic factors associated with failure to fi ll. Results The cohort consisted of 14,693 antihypertensive prescriptions, prescribed by 164 e-prescribing physicians for 7061 unique members. There were 2289 out of 14,693 prescriptions (15.6%) that went unfi lled, affecting 24.3% of patients. Of the prescriptions not obtained, 1466 (64%) were denied by the MCO and 823 (36%) were reversed. Signifi cant factors associated with fi rst-fi ll failure were new diagnosis of hypertension, new antihypertensive agent, higher co-payment, and enrollment in a health maintenance organization or preferred provider organization. Conclusions Patients newly diagnosed with hypertension and those prescribed a new antihypertensive were at particularly high risk for not obtaining their medication. Because nearly a quarter of patients did not obtain their initial fi ll of an antihypertensive prescription, future research should determine effi cient and cost-effective systems to address fi ll failure in primary care.