Abstract 13548: Full Prescription Coverage versus Usual Prescription Coverage after Coronary Artery Bypass Graft Surgery for Recent Myocardial Infarction: Analysis from the MI FREEE Randomized Trial
Background: Patients recovering from coronary artery bypass graft surgery (CABG) have poor adherence to postoperative medical therapy. Eliminating out-of-pocket costs increases medication adherence after myocardial infarction (MI). We sought to evaluate the relative effectiveness of full prescription coverage versus usual formulary coverage for patients treated with or without CABG after recent MI.
Methods: The MI FREEE (Free Rx Event and Economic Evaluation) Trial randomly assigned 5855 MI patients to full prescription coverage or usual prescription coverage for all statins, beta-blockers, angiotensin-converting-enzyme inhibitors (ACE), or angiotensin-receptor blockers (ARB). We assessed the impact of full prescription coverage on the cost, adherence, and clinical outcomes among the 1052 CABG and 4803 non-CABG patients using adjusted Cox proportion models and generalized estimating equations.
Results: CABG patients were significantly older and had a greater incidence of co-morbid illness (P<0.01) compared to non-CABG patients. After MI, CABG patients were significantly more likely to receive beta-blockers and statins, but were less likely to receive ACE/ARB therapy or clopidogrel (P<0.01). Following CABG, full prescription coverage significantly reduced patient out-of-pocket spending for drugs (P=0.001) without increasing overall health expenditures (P=NS). As compared with usual coverage, full coverage significantly increased rates of adherence to secondary preventative medications (statins: 52.2% versus 40.8%; beta-blockers: 44.1% versus 36.3%; ACE/ARB therapy: 41.8% versus 32.6%; full coverage versus usual coverage; all P<0.05). Full prescription coverage was also associated with non-significant reductions in the rate of major vascular events for patient treated with CABG (HR: 0.77; 95% CI: 0.54, 1.10) or without CABG (HR: 0.87; 95% CI: 0.74, 1.02), with no interaction noted (P=NS).
Conclusion: As compared with usual prescription coverage,providing full prescription drug coverage after CABG significantly increased adherence to secondary preventative therapy, reduced patient out-of-pocket costs, and was associated with a trend towards improved clinical outcomes.
- © 2012 by American Heart Association, Inc.