Low Use of FDA-Approved Medications for Sickle Cell Disease in Adults

As the landscape of treatments for sickle cell disease (SCD) shifts, relatively little is known regarding the rates of medication prescription for SCD at a population level. This study was a cross-sectional annualized cohort analysis that used North Carolina Medicaid claims data from 2018 through 2022 to examine rates of prescription of FDA-approved medications for SCD and factors associated with their use. Adults with SCD were identified using a standard administrative data algorithm, and their data were aggregated to the person-year level. Annual prescription rates (≥ 1 claim) of hydroxyurea, L-glutamine, voxelotor, crizanlizumab, and opioid analgesics were calculated over time, and binomial mixed effects models examined associations between prescription and individual characteristics. Among 1733 individuals, the rate of hydroxyurea prescription ranged from 24.2%-26.7%. Rates for L-glutamine, voxelotor, and crizanlizumab were less than 6.0% each year. The rate of opioid prescription ranged from 51.4%-53.9%. Seeing a hematologist was consistently associated with higher odds of receiving SCD-specific medications. Age was associated with decreased prescription of hydroxyurea, L-glutamine, and opioids, but increased prescription of voxelotor. Males had higher odds of receiving hydroxyurea. Although use of FDA-approved medications for SCD was low, improved access to hematologists may increase medication utilization.