P2Y12 Inhibitor Copayment Program Did Not Improve Outcomes for MI Patients

A recent clinical trial found that while reducing copayments for myocardial infarction (MI) patients taking P2Y12 receptor inhibitors improved adherence, it did not impact clinical outcomes after 1 year.

The ARTEMIS (Affordability and Real-world Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) studied how copayment relief impacted prescription, utilization, and outcomes of P2Y12 receptor inhibitors. 

Study results showed that nonadherence was lower in the copayment group compared with the usual care group, with 13% vs 16.2%, respectively. However, rates of major adverse cardiac events remained similar between the two study groups (10.2% vs 10.6%). Additionally, secondary outcomes were also similar between both groups, including death and recurrent MI.

“The results of this trial indicate that while copayment reduction significantly affected clinician’s choice of P2Y12 inhibitor use post-acute coronary syndrome presentation and improved patient persistence with treatment, it did not impact clinical outcomes at 1 year,” Dharam J. Kumbhani, MD, SM, FACC, assistant professor of medicine at the UT Southwestern Medical Center, and colleagues wrote in their study. “Further, even among patients who were in the intervention arm, nearly one in three did not use their vouchers.”

The researchers noted that copayment relief alone is not a substantial strategy for improved medication outcomes among MI patients. 

“These results are similar to the MI FREEE trial, where providing medication free (no copayment) for statins, beta-blockers, and angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker to patients recently discharged with a MI improved medication adherence and lowered patient costs, but did not improve patient outcomes,” Dr Kumbhanis and colleagues concluded. “This further reinforces that copayment reduction/elimination should part of a multi-pronged strategy to enhance medication persistence and outcomes, rather than as a solution set in itself.”