Copayment Elimination Ups Post-MI Medication Adherence

Enhanced coverage also decreases patient spending without increasing overall health costs

MONDAY, Nov. 14 (HealthDay News) -- For patients discharged after a myocardial infarction, the elimination of copayments for medications improves adherence, but does not significantly reduce the rates of first major vascular event or revascularization, according to a study published online Nov. 14 in the New England Journal of Medicine to coincide with presentation at the American Heart Association's Scientific Sessions 2011, held from Nov. 12 to 16 in Orlando, Fla.

Niteesh K. Choudhry, M.D., from the Brigham and Women's Hospital in Boston, and colleagues investigated whether eliminating out-of-pocket costs would increase medication adherence and improve outcomes in patients after myocardial infarction. Participants were randomized to receive full prescription coverage (1,494 plan sponsors with 2,845 patients), or usual prescription coverage (1,486 sponsors with 3,010 patients). The first major vascular event or revascularization was the primary outcome. Rates of medication adherence, total major vascular event or revascularization, the first major vascular event, and health expenditures were the secondary outcomes.

The investigators found that the usual prescription group had adherence rates ranging from 35.9 to 49.0 percent, with significantly higher rates in the full coverage group (4 to 6 percent higher). The two groups did not differ significantly for the primary outcome (hazard ratio [HR], 0.93; P = 0.21). The full coverage group did have lower total major vascular events or revascularization rates and first major vascular event rates (HRs, 0.89 and 0.86, respectively; P = 0.03 for both). Total spending was not significantly increased by eliminating copayments, but patient costs for drugs and other services were significantly reduced.

"The elimination of copayments for drugs prescribed after myocardial infarction did not significantly reduce rates of the trial's primary outcome," the authors write.

Several authors disclosed financial relationships with pharmaceutical and medical insurance companies, including Aetna, which partially funded the study.

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