ORLANDO, FL—Eliminating out-of-pocket costs for prescription drugs after a myocardial infarction (MI) improves adherence and reduces the risk of major cardiovascular events, but does not reduce revascularization rates. The study findings were presented during a late breaking clinical trial session on Monday, November 14, 2011, at the American Heart Association Scientific Sessions and simultaneously published online ahead of print in the New England Journal of Medicine.

For the MI FREEE (post-Myocardial Infarction Free Rx Event and Economic Evaluation) trial, researchers led by Niteesh K. Choudhry, MD, PhD, of Brigham and Women’s Hospital (Boston, MA), randomized post-MI patients by their insurance plan sponsor to full prescription coverage (n = 2,845 patients) or usual prescription coverage (n = 3,010 patients) for all prescribed statins, beta-blockers, ACE inhibitors, or angiotensin-receptor blockers (ARBs). The trial was conducted among Aetna beneficiaries discharged a mean of 49 days post-MI using discharge claims submitted by hospitals.

Fewer Events

Overall, medication adherence in the full-coverage group was significantly higher across all 3 classes of drugs compared with the usual coverage group (table 1).

Table 1. Medication Adherence^a

^a P < 0.001 for all comparisons.

Additionally, the percentage of patients fully adherent to therapy was 41% higher for all 3 classes of medications in the full-coverage group compared with the usual coverage group (P < 0.001).

For the primary endpoint of first major vascular event or revascularization, rates were similar for full coverage vs. usual coverage (17.6% vs. 18.8%; P = 0.21). However, the rates of total major vascular events or revascularization were significantly reduced in the full coverage group (21.5% vs. 23.3%; P = 0.03), as was the rate of first major vascular event (11.0% vs. 12.8%; P = 0.03).

Patient Costs Reduced

When the researchers looked at cost-effectiveness, total patient spending was reduced by 26% for patients in the full coverage arm, while total healthcare spending overall was similar in the full coverage and usual coverage groups ($66,008 vs. $71,778; P = 0.68).

Dr. Choudhry said that based on the trial results, Aetna now plans to drop co-pays for some post-MI secondary prevention patients early next year, starting with those in self-funded plans.

Commenting on the trial, Eric D. Peterson, MD, of Duke University Medical Center (Durham, NC), said “While MI FREEE had only a modest impact on medication adherence and missed its primary endpoint, it showed that providing free post-MI medications could reduce total vascular events and pay for itself. Thus, widespread adoption is recommended.”

Dr. Peterson also emphasized that given the current low adherence rates of only 1 in 10 post-MI patients consistently taking all their medications, novel adherence strategies are desperately needed.

Study Details

The mean age of patients was 54 years, 75% were male. Mean monthly baseline copays in the usual coverage group were $13.35 for ACE inhibitors/ARBs, $12.83 for beta-blockers and $24.92 for statins.

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