Reducing Medication Costs Helps Heart Patients Comply with Drug Regimens

Tracy Wang, MD, associate professor of medicine at Duke University School of Medicine

Tracy Wang, MD

Research presented by the Duke Clinical Research Institute at the 67th American College of Cardiology's Annual Scientific Session found that heart attack survivors are more likely to comply with drug regimens if vouchers waive co-payments.

The finding is based on a study, known as ARTEMIS, of 11,001 people treated for myocardial infarction (MI) at 300 US hospitals between June 2015-2016. All of the patients studied had health insurance - 64% had private insurance, 42% were covered by Medicare and 9% Medicaid.

"Our study confirms some of our thoughts on how drug prices affect doctors and patients behaviors," lead author Tracy Wang, MD, associate professor of medicine, Duke University School of Medicine, said in a statement.

Removing the financial barrier may increase the use of evidence-based therapies, improve patient adherence to medications and potentially save lives.

About 17% of patients noted they did not previously fill a prescription due to cost. In the study, doctors at participating hospitals provided usual care, but selected at random, roughly half of the sites, the cost of antiplatelet medications were offset by vouchers over the course of the study's 1-year span.

Payment vouchers eliminated price differences between clopidogrel (Plavix), an older generic therapy, and ticagrelor (Brilinta), a newer and more effective version of the therapy. Clinicians had full discretion on which of the drugs to prescribe.

Findings concluded that clinicians were sensitive to patient cost concerns since more than 30% of doctors were more likely to prescribe the more effective drug when co-pays were covered.

Patients given vouchers were 16% more likely to continue taking medication for a full year, as recommended.

When patients were asked about medication use, 80%-85% reported they filled all prescriptions continuously, however, the study's analysis of pharmacy fill data indicated that only 55% were fully compliant.

Aside from the measure of medication use, researchers confirmed that more patients receiving pay vouchers adhered to recommended drug regimens, however, the improvements did not appear to result in a reduced rate of death, MI or strokes compared to patients receiving usual care.

According to Wang, only 72% of patients took advantage of the provided copayment reduction voucher, which could be an indication as to why there was no clinical improvement. For those patients that did not utilize the vouchers, they were least likely to take prescribed medications and more likely to have poorer outcomes.

While financial burdens are an issue, further studies are needed to improve adherence and clinical outcomes.

"But we still have a lot of work to do to understand how we can both measure and improve treatment adherence," Wang said. "We should consider copayment reductions as part of broader initiatives to improve medication use and clinical outcomes."

While the study found that eliminating co-payments improved medication prescribed and its use, it raises further questions.