Nixing copays for heart drugs improves outcomes for nonwhite patients

Reducing or eliminating copays for medications could go a long way toward closing the gap in cardiovascular disparities, researchers proposed in the May issue of Health Affairs. Their position is bolstered by evidence from the MI FREEE trial.

Niteesh K. Choudhry, MD, PhD, of Brigham and Women’s Hospital in Boston, first unveiled findings from the cluster randomized, controlled policy study MI FREEE (Post-Myocardial Infarction Free Rx and Economic Evaluation) in 2011 at the American Heart Association’s scientific session. The study found that eliminating copays for beta-blockers, statins and ACE inhibitors or ARBs for secondary prevention in patients who had had an MI increased medication adherence by up to 6 percent.

There was no significant reduction in the primary outcome (a composite of the first readmission for a first major vascular event or coronary revascularization) but the secondary outcomes (readmission for a major vascular event, rates of total major vascular events or revascularization) were lower in the group of patients with no cost sharing compared with those who paid copays.  

For this study, Choudhry and colleagues focused on data for the 2,387 patients who self-reported race or ethnicity in the trial. They grouped patients into either white (77.8 percent) or nonwhite (22.2 percent) populations to retain statistical power.

At baseline, nonwhite patients were more likely to be on cardiovascular medications before the index MI, had more comorbidities, had lower median incomes and were less likely to undergo an invasive procedure for the MI. During follow-up, they were less likely to be adherent to taking medications, more likely to have an adverse clinical event and had higher rates of overall healthcare spending.

Full coverage with no copays improved medication adherence in both patient groups. Having full coverage without copays significantly reduced rates of first readmission for a first major vascular event or coronary revascularization in nonwhite patients but not in white patients. It also reduced total healthcare spending by 70 percent for nonwhite patients but did not reduce spending for white patients.

“[O]ur findings support increasing the frequency with which efforts to address cardiovascular disparities are accompanied by a relatively simple policy change: reducing or eliminating copayments for medications,” they wrote. They recommended that providers encourage payers to implement policy changes to remove financial barriers to medications to improve outcomes and better meet patient needs.