Low-cost generic drug programs can potentially expand access to cardiovascular medications and thus assist patients in achieving desired cardiovascular outcomes. This study examined coverage in these programs of evidence-based core medications for atrial fibrillation, heart failure, hyperlipidemia, hypertension, post–acute coronary syndrome secondary prevention, and stable angina.
Abstract
Background:
Low-cost generic programs (LCGPs) that expand access to affordable cardiovascular disease (CVD) medicines can assist patients in achieving desired cardiovascular outcomes. It is important that LCGPs offer CVD medicines that promote evidence-based prescribing.
Objective:
To evaluate LCGPs’ coverage of evidence-based CVD medications using a clinical framework that examines coverage of core treatments, coverage of options with the highest-quality evidence, and the variety of medication options and strengths that create choices and allow dosing titration.
Design:
Cross-sectional study.
Setting:
Publicly available LCGPs in March and April 2023 in the United States.
Participants:
19 LCGPs.
Measurements:
Proportion of LCGPs that offered evidence-based CVD medicines within a clinical framework for 6 CVDs (atrial fibrillation, heart failure, hyperlipidemia, hypertension, post–acute coronary syndrome secondary prevention, and stable angina) according to 4 availability metrics (breadth, choice, high-quality evidence, and titratability).
Results:
The availability of CVD medication varied by program, drug, and CVD condition. 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.
Limitation:
In-depth cost analysis was not investigated.
Conclusion:
Coverage of evidence-based medications for the 6 CVDs investigated varied by LCGP and condition. Because high availability of core CVD pharmacotherapy can enhance optimal disease state management, LCGPs should identify existing limitations in their coverage and continuously revise their formularies to improve the comprehensiveness of CVD medication coverage.
Primary Funding Source:
None.
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Author, Article, and Disclosure Information
Ivy T. Ton,
Western University of Health Sciences, Pomona, California (I.T.T., A.S., T.R.)
Western University of Health Sciences, Pomona, and VA Greater Los Angeles Healthcare System, Los Angeles, California (J.M.)
VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California (F.V.M., J.K.H.)
Western University of Health Sciences, Pomona, California; VA Greater Los Angeles Healthcare System, Los Angeles, California; ICES, Toronto, Canada; and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (C.A.J.).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0287.
Reproducible Research Statement: Study protocol: Not available. Statistical code: Not available. Data set: Available data are provided in the Appendix.
Corresponding Author: Cynthia A. Jackevicius, BScPhm, PharmD, MSc, Western University of Health Sciences, College of Pharmacy, 309 East Second Street, Pomona, CA 91766; e-mail, cjackevicius@westernu.
Author Contributions: Conception and design: J.K. Han, C.A. Jackevicius, F.V. Mody, J. Moon, T. Rahman, A. Sengul, I.T. Ton.
Analysis and interpretation of the data: J.K. Han, C.A. Jackevicius, F.V. Mody, J. Moon, T. Rahman, A. Sengul, I.T. Ton.
Drafting of the article: J.K. Han, T. Rahman, I.T. Ton.
Critical revision for important intellectual content: J.K. Han, C.A. Jackevicius, F.V. Mody, J. Moon, T. Rahman, I.T. Ton.
Final approval of the article: J.K. Han, C.A. Jackevicius, F.V. Mody, J. Moon, T. Rahman, A. Sengul, I.T. Ton.
Statistical expertise: C.A. Jackevicius, J. Moon, T. Rahman, A. Sengul, I.T. Ton.
Administrative, technical, or logistic support: C.A. Jackevicius, J. Moon, I.T. Ton.
Collection and assembly of data: J. Moon, T. Rahman, A. Sengul, I.T. Ton.
This article was published at Annals.org on 5 September 2023.
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