Adherence to beta-blocker therapy under drug cost-sharing in patients with and without acute myocardial infarction.

Abstract

OBJECTIVE:

To evaluate the effects of patient copayment and coinsurance policies on adherence to therapy with beta-adrenergic blocking agents (beta-blockers) and on the rate of initiation of beta-blocker therapy after acute myocardial infarction (MI) in a population-based natural experiment.

STUDY DESIGN:

Three sequential cohorts included British Columbia residents age 66 years and older who initiated beta-blocker therapy during time intervals with full drug coverage (2001), a $10 or $25 copayment (2002), and 25% coinsurance (2003-2004). We used linked data on all prescription drug dispensings, physician services, and hospitalizations. Follow-up of each cohort was 9 months after the policy changes.

METHODS:

We measured the proportion of subjects in each cohort who were adherent to beta-blocker therapy over time, with adherence defined as having >80% of days covered. We also measured the proportion of patients initiating beta-blocker therapy after acute MI. Policy effects were evaluated using multivariable regression.

RESULTS:

Adherence to beta-blocker therapy was marginally reduced as a consequence of the copayment policy (-1.3 percentage points, 95% confidence interval [CI] = -2.5 , -0.04) or the coinsurance policy (-0.8 percentage points, 95% CI = -2.0, 0.3). The proportion of patients initiating beta-blockers after hospitalization for acute MI remained steady at about 61% during the study period, similar to that observed in a control population of elderly Pennsylvania residents with full drug coverage.

CONCLUSIONS:

Fixed patient copayment and coinsurance policies had little negative effect on adherence to relatively inexpensive beta-blocker therapy, or initiation of beta-blockers after acute MI.

• Authors: Sebastian Schneeweiss, Amanda R Patrick, Malcolm Maclure, Colin R Dormuth, Robert J Glynn
• Journal: The American journal of managed care (Am J Manag Care) Vol. 13 Issue 8 Pg. 445-52 (Aug 2007) ISSN: 1936-2692 [Electronic] United States
• PMID: 17685825 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Acute Disease
• Adrenergic beta-Antagonists (economics, therapeutic use)
• Aged
• Aged, 80 and over
• British Columbia
• Case-Control Studies
• Cohort Studies
• Comorbidity
• Cost Sharing
• Deductibles and Coinsurance
• Diabetes Complications
• Female
• Health Policy (trends)
• Humans
• Male
• Medical Record Linkage
• Myocardial Infarction (drug therapy, economics)
• Patient Compliance (statistics & numerical data)
• Prescription Fees
• Vascular Diseases