title: Full coverage for preventive medications after myocardial infarction.
abstract: BACKGROUND
  Adherence to medications that are prescribed after myocardial infarction is poor. Eliminating out-of-pocket costs may increase adherence and improve outcomes.
  
  
  METHODS
  We enrolled patients discharged after myocardial infarction and randomly assigned their insurance-plan sponsors to full prescription coverage (1494 plan sponsors with 2845 patients) or usual prescription coverage (1486 plan sponsors with 3010 patients) for all statins, beta-blockers, angiotensin-converting-enzyme inhibitors, or angiotensin-receptor blockers. The primary outcome was the first major vascular event or revascularization. Secondary outcomes were rates of medication adherence, total major vascular events or revascularization, the first major vascular event, and health expenditures.
  
  
  RESULTS
  Rates of adherence ranged from 35.9 to 49.0% in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group (P<0.001 for all comparisons). There was no significant between-group difference in the primary outcome (17.6 per 100 person-years in the full-coverage group vs. 18.8 in the usual-coverage group; hazard ratio, 0.93; 95% confidence interval [CI], 0.82 to 1.04; P=0.21). The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group (21.5 vs. 23.3; hazard ratio, 0.89; 95% CI, 0.90 to 0.99; P=0.03), as was the rate of the first major vascular event (11.0 vs. 12.8; hazard ratio, 0.86; 95% CI, 0.74 to 0.99; P=0.03). The elimination of copayments did not increase total spending ($66,008 for the full-coverage group and $71,778 for the usual-coverage group; relative spending, 0.89; 95% CI, 0.50 to 1.56; P=0.68). Patient costs were reduced for drugs and other services (relative spending, 0.74; 95% CI, 0.68 to 0.80; P<0.001).
  
  
  CONCLUSIONS
  The elimination of copayments for drugs prescribed after myocardial infarction did not significantly reduce rates of the trial's primary outcome. Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs. (Funded by Aetna and the Commonwealth Fund; MI FREEE ClinicalTrials.gov number, NCT00566774.).
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. nchoudhry@partners.org
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Michele
authors.initials: M
authors.lastname: Toscano
authors.forename: Lonny
authors.initials: L
authors.lastname: Reisman
authors.forename: Joaquim
authors.initials: J
authors.lastname: Fernandes
authors.forename: Claire
authors.initials: C
authors.lastname: Spettell
authors.forename: Joy L
authors.initials: JL
authors.lastname: Lee
authors.forename: Raisa
authors.initials: R
authors.lastname: Levin
authors.forename: Troyen
authors.initials: T
authors.lastname: Brennan
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D003669:Deductibles and Coinsurance; D016527:Drug Costs / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D019458:Insurance Coverage; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D019233:Retreatment; D014481:United States; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors