A new study by researchers at CVS Caremark, Aetna and Brigham and Women’s Hospital finds that eliminating medication copays can significantly improve medication adherence and health outcomes for non-white patients. The research, published in the May 2014 issue of Health Affairs, suggests that this approach may be an effective strategy for reducing commonly recognized disparities in cardiovascular care related to patient ethnicity and race.
Racial and ethnic disparities in cardiovascular care have been widely documented in peer-reviewed literature and persist despite overall improvements in cardiovascular mortality and risk factor control. In fact, earlier research by CVS Caremark and Brigham and Women's Hospital published in 2013 in The American Heart Journal found that non-white patients had 50 percent greater odds of medication non-adherence to statin medications compared to white patients.
The new research was a secondary analysis of an earlier study conducted by Brigham and Women’s Hospital, Harvard Medical School and Aetna. The original study compared adherence and health outcomes for patients who had full drug coverage (i.e., no copayments, coinsurance or deductibles) versus patients with usual drug insurance coverage for medications commonly prescribed after a heart attack (i.e., statins, beta-blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers). In the new study, the researchers reviewed the existing data to see whether providing full coverage for these medications had differential effects based on race and ethnicity. More than 2,300 individuals were included in the analysis of which 22.2 percent self-identified as being of non-white race/ethnicity.
The study found that:
- For all patients, full coverage significantly improved medication adherence.
- Providing full drug coverage significantly reduced rates of a post-heart attack major vascular event or revascularization among patients who self-identified as being non-white, but had no impact on clinical events for individuals of white race or ethnicity.
- Providing full drug coverage reduced total health care spending by 70 percent among patients who self-identified as being non-white.
This new research demonstrates that eliminating medication copays can help reduce disparities in care related to a patient’s race or ethnicity. This approach is known as value based insurance design (VBID).