Effect of Medication Co-payment Vouchers on P2Y<sub>12</sub> Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial Infarction

Wang, Tracy Y.; Kaltenbach, Lisa A.; Cannon, Christopher P.; Fonarow, Gregg C.; Choudhry, Niteesh K.; Henry, Timothy D.; Cohen, David J.; Bhandary, Durgesh; Khan, Naeem; Anstrom, Kevin J.; Peterson, Eric D.

doi:10.1001/jama.2018.19791

Cited by 75 publications

(68 citation statements)

References 41 publications

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“…The aforementioned MI FREEE RCT found that free coverage for essential cardiovascular medications post-myocardial infarction increased adherence by 4 to 6% ( p < 0.001) but did not improve the primary outcome of the first major vascular event or procedure [ 20 ]. More recently, the ARTEMIS trial also found that provision of free access to P2Y 12 inhibiting anti-platelet agents for a year increased adherence by a small amount (2.3%), but there was no difference in major adverse cardiovascular events [ 63 ]. In addition, since patients are frequently taking medications that are not essential and may be harmful, decreased adherence to these medications may not lead to adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

et al. 2021

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Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, are unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes. Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools. Results Twenty-six studies of varying quality (n = 483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1 to 10.2%. Factors predicting CRNA included high out-of-pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at 1 year. Conclusion CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

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Section: Discussionmentioning

confidence: 99%

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

et al. 2021

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“…Lowering prescription copayment has also been tested in patients after MI hospitalization who were recommended to use antiplatelet therapy for 1 year. The ARTEMIS trial randomized 11 001 patients with MI across 301 US hospitals to either the intervention group where copayment vouchers were provided to eliminate the prescription costs of clopidogrel or ticagrelor for 1 year, or the usual care group without vouchers . Medication persistence, defined as patient‐reported use of P2Y12 inhibitors without a gap of 30 days or longer, was significantly higher in the intervention group compared to control after adjusting for baseline characteristics (2.3%; 95% CI, 0.4‐4.1).…”

Section: Implementation Strategies To Improve Preventive Care In Patimentioning

confidence: 99%

Opportunities for improving use of evidence‐based therapy in patients with type 2 diabetes and cardiovascular disease

Gao

Peterson

Pagidipati

2019

Clinical Cardiology

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Evidence‐based therapy that target hyperlipidemia, hypertension, smoking cessation, and weight loss have demonstrated significant benefits in reducing cardiovascular risks and related events. Although the benefit of intensively lowering blood glucose is unclear, newer antidiabetic drugs (glucagon‐like peptide‐1 receptor agonists and sodium‐glucose cotransporter‐2 inhibitors) have shown cardiovascular benefits in addition to their antihyperglycemic effect. Yet, studies suggest that recent use of evidence‐based therapy and management of cardiovascular risk among individuals with type 2 diabetes (T2D) and cardiovascular disease (CVD) remains largely suboptimal. The following narrative review first identifies barriers to translating research evidence to clinical practice at the levels of provider, health system, patient, and cost. Then it synthesizes previous implementation strategies that addressed multifaceted barriers and attempted to improve care for patients with T2D and CVD. In conclusion, team‐based care coordination, reminding systems in combination to pharmacist consultation and patient education, provider education compatible with clinical workflow, and coupled incentives between providers and patients appeared to be effective in reducing cardiovascular risks for patients with T2D and CVD, though the scalability and long‐term clinical effect of these strategies as well as the possibility of interventions involving payers and health systems remain uncertain.

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“…The first issue studied was patient cost: in circumstances in which patients pay for part or all of their drug cost, poor compliance has previously been attributed to this factor. In the Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS), 12 301 US hospitals that enrolled 11,001 post-acute coronary syndrome patients randomized them to usual care or to co-payment vouchers for clopidogrel or ticagrelor for 1 year (median voucher value $137 for a 30-day supply). The co-primary outcomes were patient-reported persistence with P2Y12 inhibitor (defined as continued treatment without gap in use 30 days) and MACE (death, recurrent myocardial infarction, or stroke) at 1 year.…”

Section: Compliance Lessons From Non-statin Studiesmentioning

confidence: 99%

Improving Statin Noncompliance: If You Build It, Will They Come?

Sparrow

Legere

Udell

et al. 2019

Canadian Journal of Cardiology

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See article by Chen et al., pages 884e891 of this issue. Few things are as certain in cardiology as the knowledge that statins reduce cardiovascular (CV) events in at-risk individuals. Statins have significantly reduced the risk of death, myocardial infarction, stroke, and the need for coronary revascularization in dozens of high-quality clinical trials. 1 Risk reduction is proportional to low-density lipoprotein cholesterol (LDL-C) lowering; specifically, each 1 mmol/L reduction in LDL-C lowers CV events by 22%. 1 Other drugs that reduce LDL-C, including ezetimibe 2 and proprotein convertase subtilisin-kexin type 9 inhibitors, 3 have also been shown to reduce CV events, albeit with less impressive clinical trial evidence. Although guidelines in this area often differ with respect to details, they all endorse statin therapy for subjects at intermediate or high risk of a CV event. 4 On the basis of this information, one might expect that most patients with atherosclerotic CV disease (ASCVD) would be treated with a statin, perhaps 90%. As shown in the report from Chen et al. 5 in this issue of the Canadian Journal of Cardiology, reality falls far short of this expectation. These investigators linked 5 large databases in the province of Alberta to identify 281,665 patients with a new ASCVD diagnosis from 2011 to 2015. Only 77.9% of these patients had an LDL-C measurement, and of those with a measurement, only 65.9% were treated with a statin. Among those treated who had a follow-up LDL-C measurement, 36.6% did not achieve the modern Canadian target of either < 2 mmol/L or a 50% LDL-C reduction. Goal achievement improved from low to moderate to high-intensity statin use. Adherence, defined as taking at least 80% of medication, was similar across the 3 statin intensities and averaged 60.2%. Chen et al. characterize their findings as "a remarkable treatment gap," and we certainly agree. They detail how this gap is not unique to Alberta, but extends to the rest of Canada, 6 as well as to the United States, Europe, and most other places that have been studied. Differences among geographic locations might result from differences in patient populations studied (primary vs secondary prevention), differences in methods, differences in practice patterns, differences in the culture of therapy compliance, and variations in guideline implementation. On the basis of these findings, approximately one-third of ASCVD patients are untreated, one-third are treated but do not achieve their LDL-C targets, and one-third are treated to goal. If we assume that the patients not treated to goal obtain approximately half of the potential event reduction from treatment, then overall, approximately half of the potential CV event reduction from statins is being forfeited. Over the lifetimes of our patients with ASCVD, this is a huge missed opportunity. Is there anything that we can do to narrow this gap? Approaches to Improving Statin Compliance Thankfully, a number of options are available. Statinprescribing initiatives can be broadly categoriz...

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Effect of Medication Co-payment Vouchers on P2Y₁₂ Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial Infarction

Cited by 75 publications

References 41 publications

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

Opportunities for improving use of evidence‐based therapy in patients with type 2 diabetes and cardiovascular disease

Improving Statin Noncompliance: If You Build It, Will They Come?

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Effect of Medication Co-payment Vouchers on P2Y12 Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial Infarction

Cited by 75 publications

References 41 publications

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

Opportunities for improving use of evidence‐based therapy in patients with type 2 diabetes and cardiovascular disease

Improving Statin Noncompliance: If You Build It, Will They Come?

Contact Info

Product

Resources

About

Effect of Medication Co-payment Vouchers on P2Y₁₂ Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial Infarction