ACCESS: Does Eliminating Copays For Preventive Drugs Reduce Cardiac Events?

Providing medications for chronic diseases – for example, cholesterol-lowering, blood pressure and diabetes medications – free of charge for three years did not have a significant impact on serious health outcomes associated with those conditions among low-income seniors in Canada, according to results from the ACCESS study presented at ACC.23/WCC and simultaneously published in Circulation.

Researchers sought to determine whether eliminating all patient-borne costs could increase medication adherence and thereby improve outcomes among low-income seniors, a group considered particularly vulnerable to poor cardiovascular outcomes. The study enrolled 4,761 people aged 65 and over with an annual household income below CA$50,000 (U.S.$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. The primary endpoint was a combined rate of death, myocardial infarction (MI), stroke, coronary revascularization or hospitalization for cardiovascular-related conditions such as heart failure, coronary artery disease or diabetes.

Medication copays for 15 classes of medications known to help prevent MI, strokes and other forms of vascular disease or slow the progression of chronic kidney disease were eliminated for half of the study participants, while the other half continued to be charged medication copays as usual under the Canadian universal public pharmaceutical insurance plan for seniors, which is 30% of medication costs, to a maximum copay of CA$25 ($19) per prescription. After a median of three years, the results showed no significant difference between groups in terms of the study's primary composite endpoint.

Researchers also observed no difference in terms of quality of life or total health care costs. However, participants without copays were slightly more likely to take their medications as prescribed for several medication classes. No subgroups of patients were identified as being more likely to benefit from the elimination of copayments based on demographic or health-related factors.

According to the study investigators, several factors could explain why the intervention had no effect, including that the average cost savings to participants was more modest than expected.

"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 Braden Manns, MD, professor of medicine at the University of Calgary in Canada, and the study's senior author. "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."

Manns and colleagues said further studies could help elucidate whether a similar intervention might have more of an impact among other groups of people, such as those who are uninsured or those living in the U.S., where the average person spends $1,500 per year on prescription drugs.

Clinical Topics: Geriatric Cardiology

Keywords: ACC Annual Scientific Session, ACC23, Geriatrics, ACC.23/WCC Meeting Newspaper, ACC Scientific Session Newspaper

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