Coronary Artery Disease, Myocardial Infarction
Conditions
Keywords
myocardial infarction, secondary prevention, health insurance, cost-sharing
Brief summary
The objective of this randomized trial is to evaluate the effect of providing full prescription drug coverage (i.e. no co-pays, co-insurance or deductibles) for statins, beta-blockers, angiotensin converting enzyme inhibitors and angiotensin II receptor blockers to patients recently discharged from hospital after acute myocardial infarction.
Interventions
OTHERFull drug coverage
Patients randomized to first-dollar coverage will have their pharmacy benefits changed so that they have no out-of-pocket costs for any beta-blocker, angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) antagonist, or statin for every subsequent prescription after randomization. All co-pays and co-insurance will be waived at the point of care (i.e. pharmacy) as will any contribution that the cost of these drugs contributes to a patient's deductible
OTHERUsual coverage
Patients randomized to usual coverage will have no change in their existing benefits
Sponsors
Aetna, Inc.
Brigham and Women's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* discharged alive from hospital after acute MI * receive health services and prescription drug benefits through Aetna, Inc.
Exclusion criteria
* enrollment in a Health Savings Account (HSA) plan * age ≥ 65 years of age at the time of hospital discharge * plan sponsor has opted out of participating in the study * receive only medical services or pharmacy coverage but not both through Aetna
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| First occurrence of fatal or non-fatal acute MI, unstable angina, stroke, congestive heart failure, or revascularization (coronary bypass, stent insertion, or angioplasty) | 2.5 years |
Secondary
| Measure | Time frame |
|---|---|
| First occurrence of fatal or non-fatal acute MI, unstable angina, stroke, or congestive heart failure or out-of-hospital cardiac death | 2.5 years |
| Rate of fatal or non-fatal acute MI, unstable angina, stroke, congestive heart failure, or revascularization (coronary bypass, stent insertion, or angioplasty) | 2.5 years |
| First occurrence of fatal or non-fatal acute MI, unstable angina, stroke, or congestive heart failure | 2.5 years |
| Health care utilization (i.e. use of physician visits, emergency room admissions, hospitalizations or other resources) | 3 months |
| Total pharmacy and health care costs | 2.5 years |
| Medication adherence (i.e. the mean medication possession ratio and the proportion of patients fully adherent to each and all 3 of the study medications) | 3 months |
Countries
United States
Outcome results
None listed