Co-Payment Vouchers Increase P2Y12 Inhibitor Persistence in Patients With MI

Copay, calculator, money
Copay, calculator, money
Researchers examined the effect of a co-payment voucher to offset medication payment costs on continual P2Y12 inhibitor use and on risk for major adverse cardiovascular events at 1 year in adult patients with myocardial infarction discharged with prescriptions for clopidogrel or ticagrelor.

Providing co-payment vouchers to patients with myocardial infarction increases persistent use of P2Y12 inhibitors compared with not providing financial assistance, according to study results published in JAMA.

Researchers enrolled a total of 11,001 patients with acute myocardial infarction who were admitted to 301 hospitals and were followed for ≤1 year after discharge. Patients from participating hospitals were randomly assigned to receive either co-payment vouchers for clopidogrel or ticagrelor for ≤1 year (n=6436), with a median voucher value for a 30-day supply of $137, or usual care (n=4565) that did not rely on study vouchers. Coprimary outcomes included patient-reported persistence with P2Y12 inhibitors, which was defined as continual treatment without a gap in usage ≥30 days and major adverse cardiac events at 1-year follow-up.

The total number of patients who were discharged with prescriptions for clopidogrel or ticagrelor were 2317 and 2497 in the intervention group and usual care group, respectively. Persistence with P2Y12 inhibitors at 1 year, according to patient report, was higher among patients who received vouchers compared with controls (unadjusted rates, 87.0% vs 83.8%, respectively; P <.001; adjusted difference 2.3% [95% CI, 0.4%-4.1%]; adjusted odds ratio 1.19 [95% CI, 1.02-1.40]). Study investigators observed no difference between the intervention and usual care groups in terms of major adverse cardiac events at 1 year (unadjusted cumulative incidence, 10.2% vs 10.6%; P =.65; adjusted difference 0.66% [95% CI, −0.73% to 2.06%]; adjusted hazard ratio 1.07 [95% CI, 0.93-1.25]).

Limitations of the study included its reliance on patient-reported measures and the high number of patients who were lost to follow-up in the intervention group.

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“The majority of patients who did not use the voucher did not describe any barrier to use,” the researchers added, “suggesting that they did not need or chose not to use the provided voucher.”


Wang TY, Kaltenbach LA, Cannon CP, et al. Effect of medication co-payment vouchers on P2Y12 inhibitor use and major adverse cardiovascular events among patients with myocardial infarction: the ARTEMIS randomized clinical trial. JAMA. 2019;321(1):44-55.