Skip to content

Out-of-Pocket Costs a Barrier to CVD Patients’ Treatment

Yet another study has found that high co-pays could restrict cardiovascular disease patients’ access to prescription drugs. 

Co-Pays Affect Adherence 

Patients with pulmonary arterial hypertension who had high co-pays were significantly less likely to adhere to their treatment plans, according to researchers at the University of Pittsburgh Medical Center. This was the case regardless of their income, educational attainment or other social factors.  

The relationship proved so significant, in fact, that the authors of the study suggest high co-pays might themselves comprise “a structural barrier to medication adherence” worthy of further investigation as a matter of patient access. For heart patients, prohibitive out-of-pocket expenses are not merely inconvenient, but potentially life-threatening.  

As the study’s authors write, “lowering out‐of‐pocket medication costs has been associated with reduced health care disparities for those with chronic cardiovascular disease.” This is as much a question of health care policy as of medicine or economics, a point confirmed by the health care provisions of the recently passed Inflation Reduction Act.  

Part D Reform 

Under the new law, seniors will pay not more than $2,000 per year on out-of-pocket expenses for Medicare Part D prescription drugs starting in 2025. The new law will also eliminate the coverage gap or “donut hole” between Medicare’s initial and catastrophic benefits.  

Additionally, it will allow seniors to pay their health care expenses in monthly installments, a mechanism called “smoothing.” Seniors must opt in to this option, however, and the law permits health insurers to remove seniors from the “smoothing” benefit should they miss a monthly payment. How long seniors are banned, and other specifics remain unclear.  

Bridging the Gap 

Cardiovascular patients, with pulmonary arterial hypertension or other conditions, depend on access to prescription drugs. Good public policy — and insurers — can bridge the gap between patients and consistent adherence to their pharmaceutical treatments.

Related Articles