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Aetna to Cut Co-Pays for Heart Patients to Increase Drug Use

Aetna Inc., the third-largest health insurer in the U.S., will cut some co-payments on drugs aimed at preventing heart attacks after a study showed patients took their medicines and were healthier when there were no out-of-pocket costs for their treatments.

The research, reported today at the American Heart Association meeting in Orlando, Florida, found dropping co-pays helped 40 to 55 percent of patients take drugs as prescribed, compared with 36 to 49 percent. The move lowered heart attack and stroke risk by 14 percent, according to the study.

Failure to take treatment is a leading cause of 325,000 recurrent heart attacks suffered annually in the U.S., said Lonny Reisman, chief medical officer for the Hartford, Connecticut-based company. Aetna will end co-pays on generics used to keep heart-attack victims from having a relapse, and trim upfront costs for some branded heart drugs, he said.

“We’re moving in the right direction and pushing up patient adherence to prescriptions,” said Reisman, a cardiologist and study co-author. “The bad news is there are a lot of other things getting in the way of patients taking their medicines and even with no co-pays only about half of people are complying.”

The drugs in the co-pay program include statins such as pravastatin; beta blockers including atenolol; and ACE inhibitors such as Amlodipine Besylate-Benazepril.

The out-of-pocket expense per patient dropped about $500 with no co-pays and better outcomes.

Takes Effect in 2013

The change won’t be immediate. Aetna expects to start the program in 2013 after getting approvals from state regulators and offer it as part of 2013 contract renewals on plans with employers, Reisman said.

Aetna rose less than 1 percent to $41.68 at the close of New York trading. The research was conducted by Brigham and Women’s Hospital, Harvard Medical School and Aetna.

One of the biggest reasons why people don’t take their medications correctly is they simply forget, said Niteesh K. Choudhry, the study’s lead author and a researcher at Brigham and Women’s in Boston. They also often don’t understand how to take them, or avoid them because of side effects, he said.

“There is still a lot of work needed to move that compliance number up,” said Choudhry, an associate professor at Harvard Medical in Boston. “Eliminating the co-pays is an easy idea to tackle the problem, but it’s only a first step.”

2010 Health Law

The 2010 health-care overhaul encouraged insurers to lower or remove co-pays to help encourage patients to follow their treatment plans, according to an editorial on the trial in the New England Journal of Medicine. The study was published online today.

The study, which followed 5,855 patients who had been released from a hospital after suffering a heart attack, lowered average spending on people with no co-pays by more than $5,000 because they had fewer heart attacks, strokes or other vascular events, Choudhry said.

“While the savings wasn’t considered statistically significant, it showed it didn’t cost the insurer more to eliminate the co-pays,” Choudhry said. “And the patient benefited.”

Three-quarters of the patients in the study were male with an average age of 54. They were followed for a median duration of a little over a year.

WellPoint Pilot

Other insurers have tested the impact of eliminating co-pays on chronic conditions in pilot programs.

WellPoint Inc., the largest U.S. health insurer by enrollment, eliminated or trimmed co-pays in a project in Cincinnati to reduce hypertension and improve diabetes management. The program involved city employees and supermarket company Kroger Co., based there.

The plan, with 600 participants, lowered workers’ blood sugar, triglycerides, LDL cholesterol and systolic and diastolic blood pressure, said Lori McLaughlin, spokeswoman for Indianapolis-based WellPoint. It led to more spending on drugs and doctor visits for the plan and less on hospital and emergency room use.

There was no cost savings for the employers because of the administrative cost of the program, McLaughlin said.

Cigna Corp. in Bloomfield, Connecticut, offers plans with free generic coverage and reduced co-pays for preventive medications to treat such conditions as osteoporosis and high cholesterol and blood pressure, said spokeswoman Mariann Caprino.

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