A study of evidence-based medicines for 6 cardiovascular diseases (CVDs; atrial fibrillation, heart failure, hyperlipidemia, hypertension, post–acute coronary syndrome secondary prevention, and stable angina) shows that low-cost generic programs (LCGPs) have limitations in coverage that need to be addressed through formulary revisions. “Recently renewed interest in LCGPs may help increase awareness of these programs and improve medication availability and pharmacoequity for socioeconomically disadvantaged populations, potentially improving cardiovascular outcomes,” the authors conclude. “Health care professionals should consider medication availability and LCGP-specific characteristics when recommending their use.”
The cross-sectional study examined 19 publicly available U.S. LCGPs in Mar. and Apr. 2023. Based on 4 availability metrics (breadth, choice, high-quality evidence, and titratability), the study looked at the proportion of LGCPs that offered evidence-based CVD medicines within a clinical framework for the 6 CVDs. “The availability of CVD medication varied by program, drug, and CVD condition,” the authors report. “Some programs had more breadth and choice of coverage for most CVDs (H-E-B, Kroger, Mark Cuban Cost Plus Drug Company, and Walmart), whereas many had more focused coverage and others markedly limited offerings. Nearly all LCGPs offered angiotensin-converting enzyme inhibitors, β-blockers, thiazides, and moderate-intensity statins, but availability was low for higher-cost or lower-use generics (antiplatelets and antiarrhythmics). Core pharmacotherapy coverage and choices were limited for atrial fibrillation and heart failure but widely available for hypertension and hyperlipidemia.”
Related Letter: Using Amazon Prime and GoodRx prices as a baseline, researchers report that out-of-pocket (OOP) payments were 20% and 43% higher for commonly prescribed generic medications. The study used the 2020 Medical Expenditure Panel Survey (MEPS) data set, a nationally representative survey collecting responses from noninstitutionalized Americans to examine the 20 most commonly prescribed generic medications (other than controlled substances). In addition to the above excess prices, the study shows the following: “Out-of-pocket payments exceeded Amazon and GoodRx prices for 40% and 79% of the prescriptions assumed to be in the deductible phase, respectively. The estimated cumulative OOP cost savings, assuming patients obtained their medications using Amazon and GoodRx discount cards, amount to approximately $969 million and $1.83 billion, respectively. Most of the cumulative OOP savings were generated from 90-day prescriptions.”
“Although some discount card programs may provide temporary relief for patients’ OOP costs on select generic medications, their dependence on pharmacy benefit managers for claims adjudication and access to contracted pharmacies hinders long-term solutions,” the authors conclude. “To reduce OOP costs effectively, policy reforms facilitating the adoption of value-based insurance designs are necessary.”