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Full prescription coverage versus usual prescription coverage after coronary artery bypass graft surgery: analysis
Alexander Kulik1, Nihar R Desai, William H Shrank
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.K., N.R.D., W.H.S., E.M.A., R.J.G., R.L., N.K.C.); Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Boca Raton, FL (A.K.); Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL (A.K.); Aetna, Hartford, CT (L.R.); and CVS Caremark, Woonsocket, RI (T.B.).
Insights
Eliminating prescription costs after myocardial infarction (MI) boosts medication adherence for patients, including those who underwent coronary artery bypass graft (CABG) surgery. This strategy reduces out-of-pocket expenses and shows a trend toward better clinical outcomes.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Pharmacoeconomics
Background:
- Post-myocardial infarction (MI) adherence to preventive therapies is crucial for reducing clinical events.
- Patients undergoing coronary artery bypass graft (CABG) surgery exhibit particularly low adherence rates to medical therapy.
- Investigating the impact of eliminating out-of-pocket prescription costs is essential for this high-risk subgroup.
Purpose of the Study:
- To evaluate the effect of full prescription drug coverage on medication adherence in patients after myocardial infarction (MI).
- To assess the impact of this coverage strategy on clinical outcomes and healthcare costs, specifically in patients who underwent coronary artery bypass graft (CABG) surgery.
Main Methods:
- The MI Free Rx Event and Economic Evaluation (FREEE) trial randomized 5855 MI patients to full or usual prescription coverage.
- Analysis focused on 1052 patients who underwent CABG and 4803 who did not, assessing adherence, clinical events, and costs.
- Adjusted models were used to compare outcomes between full and usual coverage groups.
Main Results:
- Full prescription coverage significantly increased adherence to all preventive medications for patients after CABG (P<0.05).
- While not statistically significant, full coverage was associated with a trend toward reduced major vascular events or revascularization in both CABG and non-CABG groups.
- Full coverage substantially reduced out-of-pocket drug spending for CABG patients (P=0.001) without increasing overall healthcare expenditures.
Conclusions:
- Eliminating drug copayments after MI offers consistent benefits, enhancing medication adherence for both CABG and non-CABG patients.
- This policy leads to a trend of improved clinical outcomes and significantly lowers patient out-of-pocket expenses.
- Full prescription coverage is an effective strategy for improving post-MI care economics and adherence.
Background:
Eliminating out-of-pocket costs for patients after myocardial infarction (MI) improves adherence to preventive therapies and reduces clinical events. Because adherence to medical therapy is low among patients treated with coronary artery bypass graft surgery (CABG), we evaluated the impact of providing full prescription coverage to this patient subgroup.
Methods And Results:
The MI Free Rx Event and Economic Evaluation (FREEE) trial randomly assigned 5855 patients with MI to full prescription coverage or usual formulary coverage for all statins, β-blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers. We assessed the impact of full prescription coverage on adherence, clinical outcomes, and healthcare costs using adjusted models among the 1052 patients who underwent CABG at the index hospitalization and 4803 who did not. CABG patients were older and had more comorbid illness (P<0.01). After MI, CABG patients were significantly more likely to receive β-blockers and statins but were less likely to receive angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy (P<0.01). Receiving full drug coverage increased rates of adherence to all preventative medications after CABG (all P<0.05). Full coverage was also associated with nonsignificant reductions in the rate of major vascular events or revascularization for patients treated with CABG (hazard ratio, 0.91; 95% confidence interval, 0.66-1.25) or without CABG (hazard ratio, 0.93; 95% confidence interval, 0.82-1.06), with no interaction noted (Pint=NS). After CABG, full prescription coverage significantly reduced patient out-of-pocket spending for drugs (P=0.001) without increasing overall health expenditures (P=NS).
Conclusions:
Eliminating drug copayments after MI provides consistent benefits to patients treated with or without CABG, leading to increased medication adherence, trends toward improved clinical outcomes, and reduced patient out-of-pocket expenses.
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