OBJECTIVES: Minority patients have lower rates of cardiovascular medication adherence, which may be amenable to co-payment reductions. Our objective was to evaluate the effect of race on adherence changes following a statin co-payment reduction intervention. STUDY DESIGN: Retrospective analysis. METHODS: The intervention was implemented by a large self-insured employer. Eligible individuals in the intervention cohort (n = 1961) were compared with a control group of employees of other companies without such a policy (n = 37,320). As a proxy for race, we categorized patients into tertiles based on the proportion of black residents living in their zip code of residence. Analyses were performed using difference-in-differences design with generalized estimating equations. RESULTS: Prior to the new co-payment policy, adherence rates were higher for individuals living in areas with fewer black residents. In multivariable models adjusting for demographic factors, clinical covariates and baseline trends, the co-payment reduction increased adherence by 2.0% (P = .14), 2.1% (P = .15) and 6% (P < .0001) for intervention patients living in areas with the bottom, middle and top tertiles of the proportion of black residents. These results persisted after adjusting for income. CONCLUSIONS: Co-payment reduction for statins preferentially improved adherence among patients living in communities with a higher proportion of black residents. Further research is needed on the impact of value-based insurance design programs on reducing racial disparities in cardiovascular care.
OBJECTIVES: Minority patients have lower rates of cardiovascular medication adherence, which may be amenable to co-payment reductions. Our objective was to evaluate the effect of race on adherence changes following a statin co-payment reduction intervention. STUDY DESIGN: Retrospective analysis. METHODS: The intervention was implemented by a large self-insured employer. Eligible individuals in the intervention cohort (n = 1961) were compared with a control group of employees of other companies without such a policy (n = 37,320). As a proxy for race, we categorized patients into tertiles based on the proportion of black residents living in their zip code of residence. Analyses were performed using difference-in-differences design with generalized estimating equations. RESULTS: Prior to the new co-payment policy, adherence rates were higher for individuals living in areas with fewer black residents. In multivariable models adjusting for demographic factors, clinical covariates and baseline trends, the co-payment reduction increased adherence by 2.0% (P = .14), 2.1% (P = .15) and 6% (P < .0001) for intervention patients living in areas with the bottom, middle and top tertiles of the proportion of black residents. These results persisted after adjusting for income. CONCLUSIONS: Co-payment reduction for statins preferentially improved adherence among patients living in communities with a higher proportion of black residents. Further research is needed on the impact of value-based insurance design programs on reducing racial disparities in cardiovascular care.
Authors: Emily F Liu; Anna D Rubinsky; Lucia Pacca; Mahasin Mujahid; Valy Fontil; Mindy C DeRouen; Jessica Fields; Kirsten Bibbins-Domingo; Courtney R Lyles Journal: Circ Cardiovasc Qual Outcomes Date: 2022-01-31
Authors: Michael G Nanna; Ann Marie Navar; Pearl Zakroysky; Qun Xiang; Anne C Goldberg; Jennifer Robinson; Veronique L Roger; Salim S Virani; Peter W F Wilson; Joseph Elassal; L Veronica Lee; Tracy Y Wang; Eric D Peterson Journal: JAMA Cardiol Date: 2018-08-01 Impact factor: 14.676
Authors: David J T Campbell; Terry Saunders-Smith; Braden J Manns; Marcello Tonelli; Noah Ivers; Brenda R Hemmelgarn; Ross T Tsuyuki; Raj Pannu; Kathryn King-Shier Journal: Health Expect Date: 2020-10-13 Impact factor: 3.377