Eliminating Co-pays for Preventive Drugs Not Found to Reduce Cardiac Events

New research presented at the American College of Cardiology 2023 Scientific Session found that providing medications for chronic diseases free of charge for 3 years did not have a significant impact on serious health outcomes associated with those conditions among low-income seniors in Canada.

According to a press release, the trial brought an average savings of 35 Canadian dollars (CA) or $26 per month for participants in the intervention group. However, eliminating this level of co-payment did not show any significant benefits in the study’s primary endpoint, which was a combined rate of death, heart attack, stroke, coronary revascularization, or hospitalization for cardiovascular-related conditions, such as heart failure, coronary artery disease, or diabetes.

“Our findings suggest that the current policy in Alberta, Canada, is probably reasonable; even though it leaves people with some costs, they’re not overburdensome in this population,” said senior author Braden Manns, MD, a professor of medicine at the University of Calgary in Canada, in a press release. “Most experts in health policy will actually be quite surprised by this. It’s a negative trial but still one that we can learn a lot from.”

Available medications can significantly reduce the risk of cardiac events among patients with chronic diseases, such as heart disease, diabetes, and chronic kidney disease. However, earlier research has estimated that approximately 1 in 8 individuals with these conditions cite cost as a primary reason for not continuing preventive medications, and populations with lower socioeconomic status tend to have worse outcomes from chronic diseases than wealthier populations.

In their study, investigators aimed to determine whether eliminating all patient-borne costs could increase medication adherence and thereby improve outcomes among low-income seniors, who are considered particularly vulnerable to poor cardiovascular outcomes. The study enrolled 4761 individuals aged 65 years and older with an annual household income below CA$50,000, or $37,400. All participants were at high cardiovascular risk as determined by a combination of diagnosed chronic conditions and/or risk factors such as smoking, high blood pressure, and high cholesterol.

Among half of the patients, all medication co-pays were eliminated for 15 classes of medications known to prevent heart attacks, strokes, and other forms of vascular disease or slow the progression of chronic kidney disease. The rest of the participants continued to be charged co-pays as usual under the universal public pharmaceutical insurance plan for seniors, which is 30% of medication costs, to a maximum co-pay of CA$25 or $19 per prescription.

After a median of 3 years, the results showed no significant difference between groups in terms of the study’s composite endpoint. There was also no difference in terms of quality of life or total health care costs. However, participants without co-pays were slightly more likely to take their medications as prescribed for several medication classes.

The investigators identified several factors that could explain why the intervention had no effect, including that the average cost savings to participants was more modest than expected. Eliminating co-payments may have a bigger impact among those who would otherwise bear a higher cost for medications, such as those who lack health insurance.

Study participants also had a relatively high rate of medication adherence at baseline and a lower rate of cardiac events than anticipated. Other reasons aside from costs may also influence a person’s ability to access medical care and keep up with preventive medications.

“It’s not necessarily that cost isn’t an issue, but low-income people are facing many, many barriers, and cost is only 1 piece of the puzzle,” Mann said in the press release.

Although the findings suggest that the current co-pay structure in Alberta, Canada, is not overly burdensome for low-income seniors who have access to universal medication insurance, the investigators said further studies could help reveal whether a similar intervention might have more impact among other groups, such as those who are uninsured or living in the United States, where the average person spends $1500 per year on prescription drugs.

The trial incorporated a second intervention to assess whether patient education and support could improve outcomes. The 2 interventions did not affect each other and the findings from the second intervention will be reported separately.

REFERENCE

Eliminating Copays for Preventive Drugs Does Not Reduce Cardiac Events. News release. American College of Cardiology 2023 Scientific Session. March 5, 2023. Accessed March 8, 2023.