Association Between Copayment Amount and Filling of Medications for Angiotensin Receptor Neprilysin Inhibitors in Patients With Heart Failure

Background Angiotensin receptor neprilysin inhibitors (ARNI) reduce mortality and hospitalization for patients with heart failure. However, relatively high copayments for ARNI may contribute to suboptimal adherence, thus potentially limiting their benefits. Methods and Results We conducted a retrosp...

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Bibliographic Details
Published in:Journal of the American Heart Association Vol. 11; no. 24; p. e027662
Main Authors: Mukhopadhyay, Amrita, Adhikari, Samrachana, Li, Xiyue, Dodson, John A., Kronish, Ian M., Shah, Binita, Ramatowski, Maggie, Chunara, Rumi, Kozloff, Sam, Blecker, Saul
Format: Journal Article
Language:English
Published: England John Wiley and Sons Inc 20.12.2022
Wiley
Subjects:
Angiotensin Receptor Antagonists - therapeutic use
angiotensin receptor‐neprilysin inhibitor
Biphenyl Compounds - therapeutic use
copayment
Drug Combinations
Heart Failure
Humans
medication adherence
Neprilysin - antagonists & inhibitors
Original Research
out‐of‐pocket cost
Retrospective Studies
sacubitril‐valsartan
Stroke Volume
Tetrazoles - therapeutic use
Treatment Outcome
Valsartan - therapeutic use
Ventricular Function, Left
heart failure
medication adherence
out‐of‐pocket cost
sacubitril‐valsartan
angiotensin receptor‐neprilysin inhibitor
copayment
ISSN:2047-9980, 2047-9980
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Summary:Background Angiotensin receptor neprilysin inhibitors (ARNI) reduce mortality and hospitalization for patients with heart failure. However, relatively high copayments for ARNI may contribute to suboptimal adherence, thus potentially limiting their benefits. Methods and Results We conducted a retrospective cohort study within a large, multi-site health system. We included patients with: ARNI prescription between November 20, 2020 and June 30, 2021; diagnosis of heart failure or left ventricular ejection fraction ≤40%; and available pharmacy or pharmacy benefit manager copayment data. The primary exposure was copayment, categorized as $0, $0.01 to $10, $10.01 to $100, and >$100. The primary outcome was prescription fill nonadherence, defined as the proportion of days covered <80% over 6 months. We assessed the association between copayment and nonadherence using multivariable logistic regression, and nonbinarized proportion of days covered using multivariable Poisson regression, adjusting for demographic, clinical, and neighborhood-level covariates. A total of 921 patients met inclusion criteria, with 192 (20.8%) having $0 copayment, 228 (24.8%) with $0.01 to $10 copayment, 206 (22.4%) with $10.01 to $100, and 295 (32.0%) with >$100. Patients with higher copayments had higher rates of nonadherence, ranging from 17.2% for $0 copayment to 34.2% for copayment >$100 ( <0.001). After multivariable adjustment, odds of nonadherence were significantly higher for copayment of $10.01 to $100 (odds ratio [OR], 1.93 [95% CI, 1.15-3.27], =0.01) or >$100 (OR, 2.58 [95% CI, 1.63-4.18], <0.001), as compared with $0 copayment. Similar associations were seen when assessing proportion of days covered as a proportion. Conclusions We found higher rates of not filling ARNI prescriptions among patients with higher copayments, which persisted after multivariable adjustment. Our findings support future studies to assess whether reducing copayments can increase adherence to ARNI and improve outcomes for heart failure.
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For Sources of Funding and Disclosures, see page 11.
Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/JAHA.122.027662
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.122.027662