title: Medication adherence and healthcare disparities: impact of statin co-payment reduction.
abstract: OBJECTIVE
  Minority patients have lower rates of cardiovascular medication adherence, which may be amenable to co-payment reductions. Our objective was to evaluate the effect of race on adherence changes following a statin co-payment reduction intervention.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  The intervention was implemented by a large self-insured employer. Eligible individuals in the intervention cohort (n = 1961) were compared with a control group of employees of other companies without such a policy (n = 37,320). As a proxy for race, we categorized patients into tertiles based on the proportion of black residents living in their zip code of residence. Analyses were performed using difference-in-differences design with generalized estimating equations.
  
  
  RESULTS
  Prior to the new co-payment policy, adherence rates were higher for individuals living in areas with fewer black residents. In multivariable models adjusting for demographic factors, clinical covariates and baseline trends, the co-payment reduction increased adherence by 2.0% (P = .14), 2.1% (P = .15) and 6% (P < .0001) for intervention patients living in areas with the bottom, middle and top tertiles of the proportion of black residents. These results persisted after adjusting for income.
  
  
  CONCLUSIONS
  Co-payment reduction for statins preferentially improved adherence among patients living in communities with a higher proportion of black residents. Further research is needed on the impact of value-based insurance design programs on reducing racial disparities in cardiovascular care.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lewey
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Ste 3030, Boston, MA 02120. Email: nchoudhry@bwh.harvard.edu.
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics / Q000208:ethnology; D017047:Cost Sharing / Q000191:economics / Q000592:standards; D048909:Diabetes Complications / Q000191:economics / Q000208:ethnology / Q000517:prevention & control; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000592:standards; D005102:Health Expenditures; D054624:Health Status Disparities; D006331:Heart Diseases / Q000191:economics / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D007356:Insurance, Pharmaceutical Services / Q000191:economics* / Q000592:standards; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D054525:Minority Health / Q000191:economics; D009515:New Jersey / Q000453:epidemiology; D011204:Poverty Areas; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors