Eliminating Medication Copayments Reduces Disparities In Cardiovascular Care

Abstract

Substantial racial and ethnic disparities in cardiovascular care persist in the United States. For example, African Americans and Hispanics with cardiovascular disease are 10-40 percent less likely than whites to receive secondary prevention therapies, such as aspirin and beta-blockers. Lowering copayments for these therapies improves outcomes among all patients who have had a myocardial infarction, but the impact of lower copayments on health disparities is unknown. Using self-reported race and ethnicity for participants in the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial, we found that rates of medication adherence were significantly lower and rates of adverse clinical outcomes were significantly higher for nonwhite patients than for white patients. Providing full drug coverage increased medication adherence in both groups. Among nonwhite patients, it also reduced the rates of major vascular events or revascularization by 35 percent and reduced total health care spending by 70 percent. Providing full coverage had no effect on clinical outcomes and costs for white patients. We conclude that lowering copayments for medications after myocardial infarctions may reduce racial and ethnic disparities for cardiovascular disease.

Racial and Ethnic Disparities in the Quality of Health Care

“…In one study, organizational policy, i.e., mandatory clinical decision support, eliminated racial disparities in VTE prophylaxis (89). In another study, the elimination of copayments for cardiovascular therapy substantially reduced racial and ethnic disparities in patient adherence and cardiovascular outcomes (30). Clinician and patient factors interact with each other, as exemplified by clinician-patient communication (type C disparity).…”

Consumers and Carers Versus Pharmacy Staff: Do Their Priorities for Australian Pharmacy Services Align?

“…medication co-payments, and Safety Net thresholds for consumers are set to rise [59]. Cost impacts on medication adherence [60]: increased medication co-payments result in reduced medication utilisation and, thus, non-adherence [61,62], and full medication subsidy increases adherence [63]. It is concerning that this population, who need medication the most, may experience delays in treatment because of financial burden.…”

Healing an ailing pharmaceutical system: prescription for reform for United States and Canada

“…It reduces needed and unnecessary care to similar degrees23; is a factor in reduced adherence2425; and, for some conditions, exacerbates racial disparities in health,26 raises non-drug healthcare spending, and worsens outcomes 2426. Notably, Wales, Northern Ireland, and Scotland have been able to provide universal drug coverage without cost sharing while using other cost control mechanisms to hold drug spending well below US or Canadian levels 2728…”