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CVS research finds correlation between co-pays, adherence
May 6th, 2014
WOONSOCKET, R.I. – A new study by researchers at CVS Caremark Corp., Aetna and Brigham and Women's Hospital found that eliminating co-payments for preventive medicines for post-heart attack patients can greatly improve medication adherence and health outcomes for nonwhite patients.
CVS said that the analysis, published Monday in the May issue of the health policy journal Health Affairs, indicates that such an approach may be an effective strategy for reducing commonly recognized disparities in cardiovascular care related to patient ethnicity and race.
Racial and ethnic disparities in cardiovascular care have been well-documented in the peer-reviewed literature and persist despite overall improvements in cardiovascular mortality and risk factor control, according to CVS. The company said that research it and Brigham and Women's Hospital published last year in The American Heart Journal found that nonwhite patients had 50% greater odds of medication nonadherence to statin medications compared with white patients.
"A series of studies have demonstrated that a value-based insurance design (VBID) approach that reduces or eliminates medication co-pays is a cost-effective strategy for increasing adherence and improving cardiovascular outcomes," stated study lead author Niteesh Choudhry, associate physician in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital and associate professor at Harvard Medical School. "This new analysis demonstrates that VBID can also reduce disparities in cardiovascular care and health outcomes related to a patient's race and ethnicity."
The Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial conducted by Brigham and Women's Hospital, Harvard Medical School and Aetna originally compared full (no co-pays, co-insurance or deductibles) with usual drug insurance coverage for all statin, beta-blockers, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prescribed after a heart attack. In this new, secondary analysis, the researchers reviewed the data to see whether providing full coverage for post-MI medications had differential effects based on race and ethnicity. More than 2,300 individuals were included in the analysis, of which 22.2% self-identified as being of non-hite race/ethnicity.
The study found that for all patients, full coverage significantly improved medication adherence and that providing full drug coverage significantly reduced rates of a post-MI major vascular event or revascularization among patients who self-identified as being nonwhite but had no impact on clinical events for individuals of white race or ethnicity.
In addition, the analysis indicated that full drug coverage reduced total health care spending by 70% among patients who self-identified as being nonwhite.
"There have been a lot of studies demonstrating that disparities in care exist. This study shows us a straightforward way to reduce those disparities and improve health outcomes. We think this is an important contribution," study co-author William Shrank, senior vice president and chief scientific officer at CVS Caremark, said in a statement. "We should note that the value-based insurance design approach of eliminating co-payments for maintenance medications after a heart attack is actually a relatively simple, low-risk change that should be considered for broader usage."
CVS said its VBID program is aimed at removing the barrier of cost to help improve the medication adherence of members. There are currently more than 100 clients enrolled in the program, which targets seven chronic conditions. The program is able to provide an increase of 4% to 9% in adherence (as measured by medication possession ratio) and more than 10% improvement in moving members with suboptimal to optimal adherence in certain cardiovascular diseases, according to the company.
The new analysis of medication adherence and the impact on racial and ethnic disparities was supported by an unrestricted research grant from Aetna to Brigham and Women's Hospital, CVS said.