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Impact of restrictive prescription plans on heart failure medication use
George Thanassoulis1, Igor Karp, Karin Humphries
1Divisions of Clinical Epidemiology, Cardiology, and Internal Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Insights
Restrictive prescription plans may limit access to essential heart failure (HF) medications. Patients in provinces with stricter drug plans showed lower use of restricted HF drugs, impacting evidence-based therapy.
Area of Science:
- Pharmacoeconomics
- Cardiology
- Health Services Research
Background:
- Prescription drug plans often implement restrictions to manage costs.
- These restrictions can potentially hinder patient access to evidence-based treatments for chronic conditions.
- The study focuses on evaluating the impact of these restrictions on heart failure (HF) medication use.
Purpose of the Study:
- To assess the effect of increased prescription plan restrictions on medication adherence among heart failure patients.
- To compare medication use patterns in provinces with varying levels of prescription plan restrictiveness.
Main Methods:
- A population-based cohort study utilizing administrative data from three Canadian provinces (Quebec, Ontario, British Columbia) from 1998 to 2001.
- Drug utilization was analyzed at 30 days post-discharge, stratified by provincial prescription plan restrictiveness.
- Multivariate analyses were employed to compare the likelihood of prescribing restricted versus non-restricted HF medications.
Main Results:
- Provincial fill rates for key HF medications varied, with more restrictive plans showing lower percentages.
- For instance, beta-blocker prescriptions were significantly lower in Ontario (58%) and British Columbia (47%) compared to Quebec (34%).
- Patients in restrictive plan provinces were less likely to receive restricted drugs like beta-blockers and angiotensin receptor blockers compared to non-restricted drugs.
Conclusions:
- Living in a province with a more restrictive prescription drug plan is associated with reduced use of restricted heart failure medications.
- This association persists even when accounting for pre-existing regional variations in HF drug prescribing.
- Findings suggest that prescription plan restrictiveness can influence the uptake of guideline-recommended HF therapies.
Background:
Prescription plans frequently use restrictive strategies to control drug expenditures. Increased restrictions may reduce access to evidence-based therapy among patients with chronic disease. We sought to evaluate the impact of increased restrictions on medication use among heart failure (HF) patients.
Methods And Results:
We conducted a population-based cohort study of administrative data from 3 Canadian provinces. During 1998 to 2001, Quebec (QC) had a minimally restrictive plan, whereas Ontario (ON) and British Columbia (BC) had more restrictive prescription plans. We evaluated drug use at 30 days of discharge stratified by prescription plan. Provincial rates of filled prescriptions for HF drugs in QC, ON, and BC were 62%, 58%, and 47% for angiotensin-converting enzyme inhibitors; 34%, 22%, and 16% for beta-blockers; 9%, 5%, and 3% for angiotensin receptor blockers; and 79%, 76%, and 62% for loop diuretics, respectively. In multivariate analyses, patients residing in provinces with restrictive plans were less likely to be prescribed drugs that were restricted, such as beta-blockers (odds ratio, 0.53; 95% CI, 0.46 to 0.60; 0.36, 0.29 to 0.44, for ON and BC, respectively) and angiotensin receptor blockers (0.50, 0.45 to 0.56; 0.38, 0.32 to 0.46, for ON and BC, respectively), than drugs with no restrictions, such as loop diuretics (0.81, 0.74 to 0.88; 0.40, 0.36 to 0.45, for ON and BC, respectively) and angiotensin-converting enzyme inhibitors (0.80, 0.75 to 0.86; 0.47, 0.43 to 0.52, for ON and BC, respectively).
Conclusions:
Among HF patients, residing in a province with a more restrictive prescription plan may be associated with lower use of restricted HF medications over and above the expected regional differences in HF drug use across provinces.
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