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.
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.
Publicly available LCGPs in March and April 2023 in the United States.
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).
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.
In-depth cost analysis was not investigated.
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:
- 1. Heart disease facts. Centers for Disease Control and Prevention. Accessed at www.cdc.gov/heartdisease/facts.htm on 16 July 2022. Google Scholar
Virani SS, Alonso A, Aparicio HJ, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2021 update. Circulation. 2021;143:e254-e743. [PMID: 33501848] doi:10.1161/CIR.0000000000000950 CrossrefMedlineGoogle Scholar
Eaddy MT, Cook CL, O'Day K, et al. How patient cost-sharing trends affect adherence and outcomes: a literature review. P T. 2012;37:45-55. [PMID: 22346336] MedlineGoogle Scholar
- 4. Mark Cuban Cost Plus Drug Company. Accessed at https://costplusdrugs.com on 29 October 2022. Google Scholar
- 5. Our mission. Mark Cuban Cost Plus Drugs Company. Accessed at https://costplusdrugs.com/mission on 17 July 2022. Google Scholar
Gatwood J, Tungol A, Truong C, et al. Prevalence and predictors of utilization of community pharmacy generic drug discount programs. J Manag Care Pharm. 2011;17:449-455. [PMID: 21787030] doi:10.18553/jmcp.2011.17.6.449 CrossrefMedlineGoogle Scholar
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation. 2019;140:e125-e151. [PMID: 30686041] doi:10.1161/CIR.0000000000000665 CrossrefMedlineGoogle Scholar
January CT, Wann LS, Alpert JS, et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014;130:e199-e267. [PMID: 24682347] doi:10.1161/CIR.0000000000000041 CrossrefMedlineGoogle Scholar
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:2199-2269. [PMID: 29146533] doi:10.1016/j.jacc.2017.11.005 CrossrefMedlineGoogle Scholar
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082-e1143. [PMID: 30586774] doi:10.1161/CIR.0000000000000625 CrossrefMedlineGoogle Scholar
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596-e646. [PMID: 30879355] doi:10.1161/CIR.0000000000000678 CrossrefMedlineGoogle Scholar
Smith SC Jr, Benjamin EJ, Bonow RO, et al; World Heart Federation and the Preventive Cardiovascular Nurses Association. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458-2473. [PMID: 22052934] doi:10.1161/CIR.0b013e318235eb4d CrossrefMedlineGoogle Scholar
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:2564-2603. [PMID: 23182124] doi:10.1016/j.jacc.2012.07.012 CrossrefMedlineGoogle Scholar
Heidenreich PA, Bozkurt B, Aguilar A, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022;145:e895-e1032. [PMID: 35363499] doi:10.1161/CIR.0000000000001063 CrossrefMedlineGoogle Scholar
- 15. American College of Cardiology, American Heart Association issue coronary artery revascularization guideline. American Heart Association. 9 December 2021. Accessed at https://newsroom.heart.org/news/american-college-of-cardiology-american-heart-association-issue-coronary-artery-revascularization-guideline on 15 April 2023. Google Scholar
- 16. Top 100 chains by pharmacy dollar volume and pharmacy count. Chain Drug Review. Accessed at http://chaindrugreviewmediakit.hotims.com/r5/showkiosk.asp?listing_id=3415271 on 15 April 2023. Google Scholar
- 17. Fein AJ. The top 15 U.S. pharmacies of 2021: market shares and revenues at the biggest companies. Drug Channels. 8 March 2022. Accessed at www.drugchannels.net/2022/03/the-top-15-us-pharmacies-of-2021-market.html on 15 April 2023. Google Scholar
- 18. U.S. National Pharmacy Market Summary 2021. IQVIA. 23 November 2021. Accessed at www.iqvia.com/locations/united-states/library/publications/us-national-pharmacy-market-summary-2021 on 15 April 2023. Google Scholar
- 19. TOPS $3.99+Plan Generics program. Needy Meds. Accessed at www.needymeds.org/discountdrugprogram.taf?_function=detail&programID=90 on 15 April 2023. Google Scholar
- 20. Walgreens Prescription Savings Club. Needy Meds. Accessed at www.needymeds.org/discountdrugprogram.taf?_function=detail&programID=13 on 15 April 2023. Google Scholar
- 21. Red Book. Micromedex. Accessed at www-micromedexsolutions-com.proxy.westernu.edu/micromedex2/librarian/CS/BC004F/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIELDSYNC/5B8B3B/ND_PG/evidencexpert/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFActionId/redbook.FindRedBook?navitem=topRedBook&isToolPage=true on 15 April 2023. Google Scholar
- 22. Essien U, Krumholz H. We’re depriving underserved patients of the best drugs. Medpage Today. 2 May 2022. Accessed at www.medpagetoday.com/opinion/second-opinions/98511 on 29 October 2022. Google Scholar
Lalani HS, Kesselheim AS, Rome BN. Direct-to-consumer generic drugs: a maverick approach or another exposure of market failures? Ann Intern Med. 2022;175:890-891. [PMID: 35436150] doi:10.7326/M22-0740 LinkGoogle Scholar
- 24. Mark Cuban Cost Plus Drug Company (@costplusdrugs). Twitter. Accessed at https://twitter.com/costplusdrugs on 29 October 2022. Google Scholar
Jackevicius CA, Choi K, Krumholz HM. Access to evidence-based statins in low-cost generic drug programs. Circ Cardiovasc Qual Outcomes. 2016;9:785-787. [PMID: 27803089] doi:10.1161/CIRCOUTCOMES.116.002985 CrossrefMedlineGoogle Scholar
- 26. Medical care premiums in the United States, March 2020. U.S. Bureau of Labor Statistics. Accessed at www.bls.gov/ncs/ebs/factsheet/medical-care-premiums-in-the-united-states.htm on 15 April 2023. Google Scholar
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.