• Nan Huo, Li Chen, Ullah MishukAhmedAAuburn University Harrison School of Pharmacy, Auburn, AL, USA., Chao Li, Richard A Hansen, Ilene Harris, Zippora Kiptanui, Zhong Wang, Sarah K Dutcher, and Jingjing Qian.
• Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
• Endocrine. 2020 May 1; 68 (2): 336-348.

PurposeGeneric levothyroxine has been approved and available since 2004 but its substitution remains controversial. Therefore, the objective was to examine patterns of and identify factors associated with initiation and substitution of generic levothyroxine treatment.MethodsThis was a retrospective observational study, including new users of brand and generic levothyroxine in 2013-2015 Medicare (n = 15,877) or 2011-2012 Medicaid (n = 9390) administrative claim databases. The primary outcomes included (1) generic levothyroxine initiation, and (2) among brand-new users, generic levothyroxine substitution in 12 months. The factors associated with generic levothyroxine initiation and substitution were measured.ResultsAmong all levothyroxine new users, Medicare beneficiaries had a higher proportion of generic levothyroxine initiation than Medicaid beneficiaries (66.40% vs. 44.04%, respectively). Medicare beneficiaries' demographic factors, and health service utilizations were associated with generic levothyroxine initiation. Medicaid beneficiaries who were male and residing in the northeast region and rural areas were more likely to initiate generic levothyroxine. Among brand levothyroxine new users, the generic substitution rate was higher in the Medicare than the Medicaid cohort (18.26 vs. 3.88%). Medicare brand levothyroxine new users' demographic factors and health service utilizations were associated with generic levothyroxine substitution. Medicaid brand levothyroxine new users who were residing in the northeast region, with more prior hospitalization, and initiating a lower dosage of brand levothyroxine, had higher rates of generic substitution.ConclusionPatient demographic factors and health service utilizations are associated with generic levothyroxine initiation and substitution. Educational outreach programs targeted to increase generic levothyroxine use and prescription savings should be tailored based on different patient populations.

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