Will full health plan coverage of prescription medications improve patient adherence to post-discharge treatment regimens, resulting in better outcomes and reduced costs? That has been the big theory recently tested in the MI FREEE trial (Post-Myocardial Infarction Free Rx Event and Economic Evaluation) recently published in the New England Journal of Medicine.

Nearly 6,000 post-myocardial infarction (MI) patients were randomized to either full prescription coverage or usual prescription coverage for statins, β-blockers, ACE inhibitors, or ARBs. For the primary outcome of revascularization plus major cardiac events combined, the difference was not statistically significant.

However, enhanced prescription coverage slightly improved medication adherence and first major vascular events, and decreased patient spending without increasing overall health costs. The rate of adherence increased for all drug categories with full prescription coverage:

ACE inhibitor or ARB increased from 35.9% to 41.1%

β-blocker increased from 45% to 49.3%

Statins increased from 49% to 55.1%

Although the study is positive overall, it reveals that cost is not the only barrier to better patient adherence to post-MI drug regimens. In an accompanying editorial, Columbia University’s Lee Goldman, MD,  and Harvard University’s Arnold Epstein, MD, write that “perhaps the most sobering findings were both the low baseline adherence and the small improvement in adherence in what should have been a highly motivated group of patients after myocardial infarction.”

Physician’s Weekly wants to know…

  • Is reducing or eliminating the costs of highly beneficial medicines still a key component of increasing adherence?
  • What else, if anything, can be done?