Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery

Abstract

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 ( P int =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.

Medication Adherence: Truth and Consequences

“…Thus, value-based insurance design with reduced co-payments for services and medications should result in improvements in medication adherence and disease control, and reductions in healthcare costs. 79 Sokol et al 80 in an observational study of greater than 130,000 patients found that with greater adherence there were higher medication costs, but also a net reduction in overall healthcare costs and an estimated return on investment of 7:1 for diabetes and 4:1 for hypertension.…”

Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: a systematic review

“…Increased adherence to all three medications for the patient subgroup undergoing CABG was found, post hoc (OR 1.67, 95% CI 1.04 to 2.67; p=0.03). 41 …”

Association Between Pharmacy Closures and Adherence to Cardiovascular Medications Among Older US Adults

“…The reductions in adherence from pharmacy closure that we document are of a similar magnitude as gains that have been observed with adherence interventions designed to improve the affordability of prescription drugs. 6 , 19 , 20 For example, eliminating co-payments for cardiovascular medicines among patients with a recent myocardial infarction improved adherence to statins and β-blockers by 7% to 10%. 20 Similarly, value-based insurance designs, including low cost-sharing, have been demonstrated to increase adherence by 5% to 6%, 6 while preferred networks may improve adherence by 1% to 2%.…”