TY - JOUR
T1 - Impact of a copayment reduction intervention on medication persistence and cardiovascular events in hospitals with and without prior medication financial assistance programs
AU - Doll, Jacob A.
AU - Kaltenbach, Lisa A.
AU - Anstrom, Kevin J.
AU - Cannon, Christopher P.
AU - Henry, Timothy D.
AU - Fonarow, Gregg C.
AU - Choudhry, Niteesh K.
AU - Fonseca, Eileen
AU - Bhalla, Narinder
AU - Eudicone, James M.
AU - Peterson, Eric D.
AU - Wang, Tracy Y.
N1 - Funding Information:
IQR indicates interquartile range. *Hospital performs this for >50% of all myocardial infarction patients before hospital discharge. †Discount vouchers include coupons distributed by pharmaceutical manufacturers, prescription benefit managers, pharmacies, or marketing companies. ‡Prescription assistance programs are generally funded by pharmaceutical companies to provide lower cost medications to applicants that demonstrate financial need.
Publisher Copyright:
© 2020, American Heart Association Inc.. All rights reserved.
PY - 2020/4/21
Y1 - 2020/4/21
N2 - BACKGROUND: Hospitals commonly provide a short-term supply of free P2Y12 inhibitors at discharge after myocardial infarction, but it is unclear if these programs improve medication persistence and outcomes. The ARTEMIS (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) trial randomized hospitals to usual care versus waived P2Y12 inhibitor copayment costs for 1-year post-myocardial infarction. Whether the impact of this intervention differed between hospitals with and without pre-existing medication assistance programs is unknown. METHODS AND RESULTS: In this post hoc analysis of the ARTEMIS trial, we examined the associations of pre-study free medication programs and the randomized copayment voucher intervention with P2Y12 inhibitor persistence (measured by pharmacy fills and patient report) and major adverse cardiovascular events using logistic regression models including a propensity score. Among 262 hospitals, 129 (49%) offered pre-study free medication assistance. One-year P2Y12 inhibitor persistence and major adverse cardiovascular events risks were similar between patients treated at hospitals with and without free medication programs (adjusted odds ratio 0.93, 95% CI, 0.82–1.05 and hazard ratio 0.92, 95% CI, 0.80–1.07, respectively). The randomized copayment voucher intervention improved persistence, assessed by pharmacy fills, in both hospitals with (53.6% versus 44.0%, adjusted odds ratio 1.45, 95% CI, 1.20–1.75) and without (59.0% versus 48.3%, adjusted odds ratio 1.46, 95% CI, 1.25–1.70) free medication programs (Pinteraction =0.71). Differences in patient-reported persistence were not significant after adjustment. CONCLUSIONS: While hospitals commonly report the ability to provide free short-term P2Y12 inhibitors, we did not find association of this with medication persistence or major adverse cardiovascular events among patients with insurance coverage for prescription medication enrolled in the ARTEMIS trial. An intervention that provided copayment assistance vouchers for 1 year was successful in improving medication persistence in hospitals with and without pre-existing short-term medication programs.
AB - BACKGROUND: Hospitals commonly provide a short-term supply of free P2Y12 inhibitors at discharge after myocardial infarction, but it is unclear if these programs improve medication persistence and outcomes. The ARTEMIS (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) trial randomized hospitals to usual care versus waived P2Y12 inhibitor copayment costs for 1-year post-myocardial infarction. Whether the impact of this intervention differed between hospitals with and without pre-existing medication assistance programs is unknown. METHODS AND RESULTS: In this post hoc analysis of the ARTEMIS trial, we examined the associations of pre-study free medication programs and the randomized copayment voucher intervention with P2Y12 inhibitor persistence (measured by pharmacy fills and patient report) and major adverse cardiovascular events using logistic regression models including a propensity score. Among 262 hospitals, 129 (49%) offered pre-study free medication assistance. One-year P2Y12 inhibitor persistence and major adverse cardiovascular events risks were similar between patients treated at hospitals with and without free medication programs (adjusted odds ratio 0.93, 95% CI, 0.82–1.05 and hazard ratio 0.92, 95% CI, 0.80–1.07, respectively). The randomized copayment voucher intervention improved persistence, assessed by pharmacy fills, in both hospitals with (53.6% versus 44.0%, adjusted odds ratio 1.45, 95% CI, 1.20–1.75) and without (59.0% versus 48.3%, adjusted odds ratio 1.46, 95% CI, 1.25–1.70) free medication programs (Pinteraction =0.71). Differences in patient-reported persistence were not significant after adjustment. CONCLUSIONS: While hospitals commonly report the ability to provide free short-term P2Y12 inhibitors, we did not find association of this with medication persistence or major adverse cardiovascular events among patients with insurance coverage for prescription medication enrolled in the ARTEMIS trial. An intervention that provided copayment assistance vouchers for 1 year was successful in improving medication persistence in hospitals with and without pre-existing short-term medication programs.
KW - medication adherence
KW - myocardial infarction
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85083914567&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083914567&partnerID=8YFLogxK
U2 - 10.1161/JAHA.119.014975
DO - 10.1161/JAHA.119.014975
M3 - Article
C2 - 32299284
AN - SCOPUS:85083914567
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 8
M1 - e014975
ER -