Medicare Part D enrollment is not associated with improved outcomes following MI

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Adults enrolled in the Medicare Part D prescription drug plan did not have better outcomes after suffering an acute MI compared with those without coverage, according to a database analysis.

At 30 days following discharge, the all-cause death rates were 4.0 percent in patients enrolled in Part D and 3.3 percent in patients who were not enrolled, although the difference was not statistically significant. Patients with Part D coverage also had higher risks of 30-day all-cause readmissions or major cardiac events, but the researchers noted the differences were not statistically significant after they adjusted for multiple variables.

Lead researcher Abhinav Goyal, MD, MHS of Emory University in Atlanta, and colleagues published their results online in  Circulation: Cardiovascular Quality and Outcomes on Oct. 27.

Goyal noted that only 55 percent to 64 percent of patients enrolled in Part D were adherent to their medications one year after their acute MI. Physicians typically prescribe statins, beta-blockers, ACE inhibitors, ARBs and P2Y 12 antagonists following an MI. The researchers did not have information on adherence rates among patients who did not have Part D coverage.

“One might guess that being enrolled in Part D might improve your rate of taking prescription medications that are proven to help protect against future events after a heart attack,” Goyal told  Cardiovascular Business. “But what we were finding is that people enrolled in Part D actually had relatively poor adherence to these medications through one year. That might be part of the reason why it didn’t translate into lower event rates compared with those not in Part D.”

In 2006, the Centers for Medicare and Medicaid Services created the Part D program to give Medicare enrollees an option to purchase a subsidized prescription drug plan that is administered by private plans. Of the 54 million people enrolled in Medicare in 2014, approximately 37 million had Part D coverage, according to Goyal. Previous research found Part D helped decrease out-of-pocket drug spending and increase medication adherence.

In this analysis, the researchers linked Medicare data with records from the National Cardiovascular Data Registry ACTION registry-GWTG, a quality initiative program that collects information on patients with acute MI from more than 500 hospitals.

The study included 59,149 Medicare patients with acute MI treated at 502 hospitals and discharged between January 2007 and December 2010. Of the patients, 49.5 percent were enrolled in Part D by hospital discharge. The researchers mentioned that the proportion of patients in Part D increased slightly over time.

Patients with Part D coverage were more likely to have previous MI, heart failure, stroke and peripheral arterial disease and other comorbid conditions such as hypertension, dialysis, chronic lung disease and diabetes. They were also more likely to have been hospitalized within the previous 12 months.

Goyal said Medicare offers more than 1,700 Part D plans, making it difficult for patients enrolled in the program to understand their options.

“For patients who are sick to have to decipher through all of those rules in terms of coverage and the different phases of coverage, I think it’s too much for any individual no matter how educated you are to decipher,” he said. “I think it could be simpler in terms of what’s covered and what’s not. I think some education should go in conjunction with enrollment in Part D in terms of which medications actually matter because Part D just covers outpatient prescriptions without discriminating the ones that a patient really needs to reduce the risk of death following heart attack versus medications that may not be essential or potentially even contraindicated.”