High copays keep many heart failure patients from filling needed prescriptions
Heart failure patients are less likely to fill prescriptions for beneficial medications if they have a high copay, according to new data published in the Journal of the American Heart Association.[1]
“Angiotensin receptor neprilysin inhibitors (ARNIs) reduce mortality and hospitalization for patients with heart failure,” wrote first author Amrita Mukhopadhyay, MD, a cardiologist with New York University School of Medicine, and colleagues. “However, poor adherence to filling ARNI prescriptions occurs in 40% to 80% of patients and is associated with increased hospitalization and death.”
Mukhopadhyay et al. noted that the “relatively high” copays associated with ARNIs may explain this trend. There is only one FDA-approved ARNI at this time, sacubitril-valsartan, and no generic version of the medication is available to the public.
To explore this topic further, the authors examined data from more than 900 adult heart failure patients treated at a single high-volume health system from November 2020 to June 2021. The average time since initial diagnosis was two years, and all patients were followed for six months.
The authors tracked each patient’s copay, separating the patients into four groups: those with no copay (20.8% of patients), those with a copay between $0.01 a $10 (24.8%), those with a copay between $10.01 and $100 (22.4%) and those with a copay more than $100 (32%). Most patients—85.8%, to be exact—had an active ARNI prescription for the entire six-month follow-up period.
The team’s primary outcome was ARNI nonadherence, determined by whether or not the patient filled their prescription as recommended. Nonadherence was seen in 17.2% of patients with no copay, 28.9% of patients with a copay between $0.01 a $10, 27.2% of patients with a copay between $10.01 and $100 and 34.2% for patients with a copay more than $100.
Nonadherence rates were consistently lower among patients prescribed ARNI for the first time, but even then, it was the lowest among patients with no copay (2.6%) and highest among patients with a copay more than $100 (12.1%).
Age, sex and race did not appear to play a significant role in determining if a patient picked up prescriptions as recommended. However, high copayments were more likely to keep patients from filling an ARNI prescription if they came from a neighborhood with a higher socioeconomic status—and researchers had expected the opposite to be true.
“Our findings inform the hypothesis that high copayments could substantially contribute to these observed low rates of adherence, underscoring the importance of addressing cost‐related barriers to therapy,” the authors wrote. “Our results are consistent with prior literature on older classes of heart failure medications, which also found an association between increased copayment and decreased medication fill adherence.”
The team also emphasized that copays are designed to reduce the high cost of using medications and encourage patients to seek cheaper alternatives or discontinue unneeded therapy. ARNI medications are new, however, and no cheaper alternative exists. In this instance, the authors wrote, “copayments may not actually reduce total costs and likely cause harm by affecting patient adherence to proven therapy, leading to increased morbidity, mortality and an overall rise in healthcare expenditures.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.