title: Eliminating medication copayments reduces disparities in cardiovascular care.
abstract: Substantial racial and ethnic disparities in cardiovascular care persist in the United States. For example, African Americans and Hispanics with cardiovascular disease are 10-40 percent less likely than whites to receive secondary prevention therapies, such as aspirin and beta-blockers. Lowering copayments for these therapies improves outcomes among all patients who have had a myocardial infarction, but the impact of lower copayments on health disparities is unknown. Using self-reported race and ethnicity for participants in the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial, we found that rates of medication adherence were significantly lower and rates of adverse clinical outcomes were significantly higher for nonwhite patients than for white patients. Providing full drug coverage increased medication adherence in both groups. Among nonwhite patients, it also reduced the rates of major vascular events or revascularization by 35 percent and reduced total health care spending by 70 percent. Providing full coverage had no effect on clinical outcomes and costs for white patients. We conclude that lowering copayments for medications after myocardial infarctions may reduce racial and ethnic disparities for cardiovascular disease.
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Katsiaryna
authors.initials: K
authors.lastname: Bykov
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Michele
authors.initials: M
authors.lastname: Toscano
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Rawlins
authors.forename: Lonny
authors.initials: L
authors.lastname: Reisman
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Franklin
mesh_terms: D000328:Adult; D001741:Black or African American; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics* / Q000208:ethnology*; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006300:Health Services Misuse / Q000191:economics / Q000517:prevention & control; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage; D007356:Insurance, Pharmaceutical Services; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000208:ethnology / Q000517:prevention & control; D012008:Recurrence; D016903:Drug Monitoring
chemical_list: D002317:Cardiovascular Agents
keywords: Disparities; Insurance Coverage < Insurance; Pharmaceuticals