After PCI for MI, 90-day prescriptions confer better medication adherence, fewer changes

Patients who filled out 90-day rather than 30-day prescriptions demonstrated higher adherence and infrequent medication changes following post-MI hospital discharge, researchers reported.
“Patients with percutaneous coronary intervention-treated MI who filled 90-day supplies of post-MI evidence-based medications had higher 12-month medication adherence rates compared with patients who filled 30-day supplies,” Jennifer A. Rymer, MD, MBA, an interventional cardiologist at Duke Cardiology South Durham and Duke University Hospital, and colleagues wrote.
For the nationwide study, researchers evaluated 353,259 patients with MI in the National Cardiovascular Data Registry who were treated with PCI from 2011 to 2015. Researchers assessed the prevalence of 30-day vs. 90-day prescriptions of statins, beta-blockers, ACE inhibitors/angiotensin receptor blockers, and P2Y12 inhibitors after hospital discharge. Among the cohort, researchers compared prescription days’ supply, 12-month medication adherence rates by evidence-based medication class, rates of medication switches, and dosing changes.

Ninety-day evidence-based medication fill rates were uncommon: 13% for statins, 12.3% for beta-blockers, 14.6% for ACE inhibitors/angiotensin receptor blockers and 9.7% for P2Y12 inhibitors.

Patients with 90-day prescriptions had a higher likelihood of being older (median age, 69 years vs. 62 years), having prior MI (25% vs. 17.9%) or having prior PCI (30.3% vs. 19.5%; P < .01 for all) compared with patients with 30-day prescriptions.

Compared with patients with 30-day prescriptions, those with 90-day prescriptions demonstrated higher 12-month medication adherence rates for statins (83.1% vs. 75.3%), beta-blockers (72.7% vs. 62.9%), ACE inhibitors/angiotensin receptor blockers (71.1% vs. 60.9%) and P2Y12 inhibitors (78.5% vs. 66.6%; P < .01 for all).

Researchers observed infrequent medication switches and dosing changes for P2Y12 inhibitor fills in patients with 30-day prescriptions (14.7% and 0.3%) and in patients with 90-day prescriptions (6.3% and 0.2%).

According to the researchers, the greatest barrier to 90-day prescription implementation strategies are restrictions by prescription drug plans and payers.

“Our hope is that by demonstrating increased medication adherence in the post-MI population using 90-day prescription strategies, many prescription drug plans will begin to change these policies and allow for wider coverage and promotion of 90-day supplies,” the researchers wrote.

The researchers recommended possible future strategies to increase medication adherence in this population should include the following:

• Focus on changing provider prescribing practices at discharge and during follow-up.
• Increase awareness about increased adherence associated with 90-day prescription plans among prescription drug plans and payers.
• Adopt changes in electronic medical records to allow automatic generation for 90-day prescriptions instead of the 30-day prescription default.

“Our results, as well as the findings of other analyses on medication adherence and 90-day prescription, fill, indicate that 90-day prescription strategies should be more frequently considered after an MI in efforts to enhance medication adherence,” the researchers wrote.

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