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Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial.

Publication ,  Journal Article
Fanaroff, AC; Peterson, ED; Kaltenbach, LA; Anstrom, KJ; Fonarow, GC; Henry, TD; Cannon, CP; Choudhry, NK; Cohen, DJ; Atreja, N; Bhalla, N ...
Published in: Circ Cardiovasc Qual Outcomes
May 2020

BACKGROUND: Cost is frequently cited as a barrier to optimal medication use, but the extent to which copayment assistance interventions are used when available, and their impact on evidence-based medication persistence and major adverse cardiovascular events is unknown. METHODS AND RESULTS: The ARTEMIS trial (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) randomized 301 hospitals to usual care versus the ability to provide patients with vouchers that offset copayment costs when filling P2Y12 inhibitors in the 1 year post-myocardial infarction. In the intervention group, we used multivariable logistic regression to identify patient and medication cost characteristics associated with voucher use. We then used this model to stratify both intervention and usual care patients by likelihood of voucher use, and examined the impact of the voucher intervention on 1-year P2Y12 inhibitor persistence (no gap in pharmacy supply >30 days) and major adverse cardiovascular events (all-cause death, myocardial infarction, or stroke). Among 10 102 enrolled patients, 6135 patients were treated at hospitals randomized to the copayment intervention. Of these, 1742 (28.4%) never used the voucher, although 1729 (99.2%) voucher never-users filled at least one P2Y12 inhibitor prescription in the 1 year post-myocardial infarction. Characteristics most associated with voucher use included: discharge on ticagrelor, planned 1-year course of P2Y12 inhibitor treatment, white race, commercial insurance, and higher out-of-pocket medication costs (c-statistic 0.74). Applying this propensity model to stratify all enrolled patients by likelihood of voucher use, the intervention improved medication persistence the most in patients with high likelihood of voucher use (adjusted interaction P=0.03, odds ratio, 1.86 [95% CI, 1.48-2.33]). The intervention did not significantly reduce major adverse cardiovascular events in any voucher use likelihood group, although the odds ratio was lowest (0.86 [95% CI, 0.56-1.16]) among patients with high likelihood of voucher use (adjusted interaction P=0.04). CONCLUSIONS: Among patients discharged after myocardial infarction, those with higher copayments and greater out-of-pocket medication costs were more likely to use a copayment assistance voucher, but some classes of patients were less likely to use a copayment assistance voucher. Patients at low likelihood of voucher use benefitted least from copayment assistance, and other interventions may be needed to improve medication-taking behaviors and clinical outcomes in these patients. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02406677.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 2020

Volume

13

Issue

5

Start / End Page

e006182

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Purinergic P2Y Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans
 

Citation

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Fanaroff, A. C., Peterson, E. D., Kaltenbach, L. A., Anstrom, K. J., Fonarow, G. C., Henry, T. D., … Wang, T. Y. (2020). Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial. Circ Cardiovasc Qual Outcomes, 13(5), e006182. https://doi.org/10.1161/CIRCOUTCOMES.119.006182
Fanaroff, Alexander C., Eric D. Peterson, Lisa A. Kaltenbach, Kevin J. Anstrom, Gregg C. Fonarow, Timothy D. Henry, Christopher P. Cannon, et al. “Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial.Circ Cardiovasc Qual Outcomes 13, no. 5 (May 2020): e006182. https://doi.org/10.1161/CIRCOUTCOMES.119.006182.
Fanaroff AC, Peterson ED, Kaltenbach LA, Anstrom KJ, Fonarow GC, Henry TD, et al. Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial. Circ Cardiovasc Qual Outcomes. 2020 May;13(5):e006182.
Fanaroff, Alexander C., et al. “Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial.Circ Cardiovasc Qual Outcomes, vol. 13, no. 5, May 2020, p. e006182. Pubmed, doi:10.1161/CIRCOUTCOMES.119.006182.
Fanaroff AC, Peterson ED, Kaltenbach LA, Anstrom KJ, Fonarow GC, Henry TD, Cannon CP, Choudhry NK, Cohen DJ, Atreja N, Bhalla N, Eudicone JM, Wang TY. Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial. Circ Cardiovasc Qual Outcomes. 2020 May;13(5):e006182.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 2020

Volume

13

Issue

5

Start / End Page

e006182

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Purinergic P2Y Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans