WOONSOCKET, R.I. — A new study by researchers at CVS Caremark, Aetna and Brigham and Women's Hospital finds that eliminating co-pays for preventive medications prescribed for post-heart attack patients can significantly improve medication adherence and health outcomes for non-white patients, which suggests that this approach may be an effective strategy for reducing commonly recognized disparities in cardiovascular care related to patient ethnicity and race.
The findings were published today in the May issue of Health Affairs.
Racial and ethnic disparities in cardiovascular care have been widely documented in the peer-reviewed literature and persist despite overall improvements in cardiovascular mortality and risk factor control. In fact, research by CVS Caremark and Brigham and Women's Hospital published last year in the American Heart Journal, found that non-white 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 approach that reduces or eliminates medication co-pays is a cost-effective strategy for increasing adherence and improving cardiovascular outcomes," said Niteesh Choudhry, associate physician for the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, associate professor at Harvard Medical School and the lead author of the study. "This new analysis demonstrates that VBID also can 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 trial conducted by Brigham and Women's Hospital, Harvard Medical School and Aetna — full results of which were previously published in the New England Journal of Medicine in 2011 — originally compared full (i.e., no co-payments, coinsurance or deductibles) with usual drug insurance coverage for all statin, beta-blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers 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-white race/ethnicity.
The study found that:
- For all patients, full coverage significantly improved medication adherence;
- Providing full drug coverage significantly reduced rates of a post-MI major vascular event or revascularization among patients who self-identified as being non-white, but had no impact on clinical events for individuals of white race or ethnicity; and
- Providing full drug coverage reduced total healthcare spending by 70% among patients who self-identified as being non-white.
"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," said William Shrank, SVP and chief scientific officer of CVS Caremark, and a study co-author. "We should note that the value based insurance design approach of eliminating copayments for maintenance medications after a heart attack is actually a relatively simple, low-risk change that should be considered for broader usage."
CVS Caremark's VBID program offering 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 that 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 sub-optimal adherence to optimal adherence in certain cardiovascular diseases.
This 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 Caremark has been supporting a multi-year research collaboration with Brigham and Women's Hospital to better understand patient behavior, particularly around medication adherence. Annual excess healthcare costs due to medication nonadherence in the United States have been estimated to be as much as $290 billion.