Copayment Levels and Medication Adherence

Abstract

Statins play a central role in cardiovascular risk reduction. Their benefit has been demonstrated for a broad spectrum of patients, ranging from those without known vascular disease1 to those who have recently had a myocardial infarction 2 or have undergone coronary artery bypass surgery.3 Not surprisingly, statins are the most widely sold class of drugs in the United States, accounting for $18.4 billion in sales in 2007.4 Article p 390 Despite this, fewer than half of the people who qualify for lipid-modifying treatment receive it.5 Furthermore, only half of all patients who have been prescribed a statin actually adhere to this therapy. For example, 42% of Medicare patients enrolled in a pharmacy benefit program were adherent with their prescribed statin 2 years after starting treatment.6 Statin adherence rates after acute coronary syndrome do not appear to be much better,7 nor have they improved substantially over time.8 Not surprisingly, nonadherence is a central reason why many patients do not achieve their low-density lipoprotein goals,5 and patients who are nonadherent have worse clinical outcomes9 and higher healthcare costs10 than their adherent counterparts. The reasons for statin nonadherence are complex and vary from patient to patient. For some, side effects lead them to a legitimate discontinuation of therapy. Others misunderstand the importance of statin therapy …