Impact of the Cost of Prescription Drugs on Clinical Outcomes in Indigent Patients with Heart Disease

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Abstract
Study Objective. To measure the impact that economic relief for prescription drugs to indigent patients with cardiovascular disease has on indicators of disease control. Design. Prospective cohort study. Setting. University inner‐city outpatient clinic. Patients. One hundred sixty‐three indigent patients with heart disease who were uninsured or whose insurance plan did not provide prescription drug coverage and who had baseline data. Intervention. Patients were assisted in obtaining prescription drugs, free of charge, in an attempt to improve adherence to their drug regimens. Measurements and Main Results. The primary end point was to determine if cardiovascular outcome measures (i.e., international normalized ratio [INR], blood pressure, low‐density lipoprotein [LDL] cholesterol, and hospitalizations) and drug adherence improved in all patients after 6 months of prescription assistance compared with a 6‐month baseline period. In patients receiving warfarin, mean INR increased from 2.44 ± 0.64 at baseline to 2.61 ± 0.53 at 6 months (p<0.05). In patients with hypertension, mean blood pressure decreased from 138 ± 20/80 ± 11 mm Hg at baseline to 138 ± 19/78 ± 12 mm Hg at 6 months (p<0.05 for diastolic blood pressure only). The mean LDL level for patients on lipid‐lowering drugs significantly decreased from 126 ± 39 mg/dl at baseline to 108 ± 38 mg/dl at 6 months (p<0.001). For each disease measure, the improved disease control seen at 6 months persisted throughout 24 months of follow‐up. Hospitalizations for the entire cohort decreased from 85 at baseline to 49 at 6 months. Patient drug adherence improved from 48.5% at baseline to 72.7% at 6 months (p<0.001). Conclusions. Drug adherence and clinical outcomes improved, and the number of hospitalizations declined when cardiovascular drugs were obtained for patients who could not afford to pay for them. Health care insurance plans that do not provide coverage for cardiovascular prescription drugs may be more costly secondary to poor disease control and increased hospitalizations.