Free Heart Medications Improve Post-MI Outcomes and Drug Adherence

Orlando—Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs when eliminating medication copays for patients following myocardial infarction (MI), according to the results of the MI FREE (Post-Myocardial Infarction Free Rx Event and Economic Evaluation) trial. Niteesh K. Choudhry, MD, PhD, presented the findings at the AHA meeting. This study was also reported in the New England Journal of Medicine [2011;365(22):2088-2097]. Although the trial had only a “modest” impact on medication adherence and did not meet its primary end point, the results were dramatic enough that the study sponsor, Aetna, said it will waive copayments for its post-MI patients beginning January 2013, according to Dr. Choudhry. In this investigator-initiated, cluster-randomized, controlled policy study, 5855 heart attack patients who received both medical and prescription drug benefits through Aetna and discharged from the hospital following an MI were included. Patients were randomly assigned to full prescription coverage (n=2845) or usual prescription coverage (n=3010) for all statins, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs). Randomization occurred about 49 days after hospital discharge. The primary end point was the first major vascular event or revascularization. Secondary end points included rates of medication adherence, total major vascular events or revascularization, the first major vascular event, and health expenditures. The findings showed patients who paid nothing for the medications were 4% to 6% more likely to adhere to their drug therapy, compared with patients who had copayments. Researchers said that 17.6% of those with free medication had a major cardiac event (heart attack, angina, stroke, or heart failure) or underwent revascularization, compared with 18.8% of those with copayments (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.82-1.04; P=.21). This difference was not statistically significant, but when assessed separately from revascularization, there was a 14% reduction in the rate of major cardiac events, defined as fatal or nonfatal MI, unstable angina, congestive heart failure, or stroke in the full prescription drug coverage group. The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group, compared with the usual-coverage group (21.5 vs 23.3; HR, 0.89; 95% CI, 0.90-0.99; P=.03), as was the rate of the first major vascular event (11.0 vs 12.8; HR, 0.86; 95% CI, 0.74-0.99; P=.03). In the full-coverage group, rates of adherence increased 5.6% for ACE inhibitors or ARBs, 4.4% for beta-blockers, 6.2% for statins, and 5.4% for all 3 medication classes (P<.001 for all comparisons). The odds of full adherence to the study medications increased by 31% to 41% (P<.001). Furthermore, patients saved 26% on their overall out-of-pocket healthcare costs. Because they had improved health, they paid fewer copayments for physician visits in addition to savings from no drug copayments, he said. “The strategy we evaluated improves quality of care, increases medication adherence, makes healthcare more affordable for patients, and doesn’t appear to increase overall spending, and so appears very attractive for patients and payers,” he said. “We have spent billions of dollars developing medicines and testing them. Making sure patients actually take those medicines is crucial,” concluded Dr. Choudhry.