Key Findings
- Purpose
To investigate whether the length of continuous Medicaid enrollment (12- vs. 24-month coverage) affects adherence to hydroxyurea among children with SCD. - Population
Pediatric patients aged 2–16 years with SCD (HbSS and/or Sβ⁰ genotypes) enrolled in North Carolina Medicaid. Adherence was assessed in two cohorts based on duration of continuous Medicaid enrollment. - Headline Result
Children with 24-month continuous Medicaid enrollment had higher rates of “good” HU adherence, defined as ≥ 80% proportion of days covered (PDC), compared with those in the 12-month cohort. The study establishes a clear positive association between uninterrupted insurance coverage and consistent HU use. - Why It Matters
For children with SCD, consistent daily HU dosing is critical to prevent vaso-occlusive crises and long-term complications. Insurance continuity appears to be a key facilitator of medication adherence — meaning that social policy and payor stability may directly influence biomedical outcomes. - Evidence Gaps & Limitations
The analysis is retrospective and based on prescription-fill data, which may not reflect actual medication ingestion. The Medicaid-only cohort may limit generalizability to privately insured or uninsured populations, and caregiver-level factors affecting adherence were not fully explored.
Source: Journal of Sickle Cell Disease — “Adherence to and Factors Associated with Hydroxyurea Use in Children Ages 2 to 16 Years Old with Sickle Cell Disease in North Carolina Medicaid.”
Regulatory & Guideline Watch
While clinical guidelines support HU as a foundational therapy in pediatric SCD, real-world adherence remains a barrier to benefit. This study highlights health policy implications: stable insurance may be as important as prescribing the drug. As payor-based disparities persist globally, guideline implementation strategies should include support for continuous coverage and access stability in pediatric SCD populations.