A CD&D

Full prescription coverage of heart drugs could help heart attack survivors live longer and lower the nation's healthcare costs, according to an analysis reported in Circulation: Journal of the American Heart Association.

The analysis found that as many as 50% of patients significantly under-used their medications to prevent recurrence of heart attacks. The major factor cited for non-compliance – surprise! – cost.

The study looked at over-65 Medicare beneficiaries with drug coverage under the Part D drug coverage, with substantial cost-sharing, co-payments and out-of-pocket costs, taking some combination of beta blockers, ACE inhibitors or ARBs, statins and aspirin and, on average, only 50% adherent, researchers said.

Niteesh Choudhry, MD, PhD, lead author of the study and an assistant professor at Harvard Medical School and in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital (Boston), said that reducing the cost "barriers" to obtaining these medications both would improve compliance and reduce overall healthcare system costs.

Analyzing post-heart attack patients, and determine costs of care, healthcare savings and length and quality of life, the researchers found that an average cost reduction of $2,500 per Medicare beneficiary would save $1 billion for the roughly 400,000 Medicare beneficiaries who have a heart attack each year.

The average cost of the drugs is more than $400 per year. The Medicare beneficiaries receiving the Part D prescription coverage lived an average eight years and two months of Quality Adjusted Life Years (QALYs) after their initial heart attack.

Related medical costs were $114,000. Those with drug coverage without deductibles or co-pays lived an average eight years and five months QALY, with related medical costs of $111,600.

Compared to coverage under Part D, full coverage for preventive therapies would result in greater functional life expectancy of about four months and less resource use of about $2,500, according to the study. And Choudhry said this model is a viable strategy for policy makers to consider and evidence for Medicare to rethink the structure of prescription drug benefits.

"Cost-sharing for prescription drugs may be counter-productive," he said. "Sometimes, it does not lead us to reduce the over-utilization of ineffective medications, but rather it leads us to under-utilize highly effective medications."