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Formulary Restrictions May Worsen Atrial Fibrillation Outcomes

Risk for adverse health outcomes higher for patients with Medicare Part D plans limiting access to non-vitamin K antagonist oral anticoagulants

FRIDAY, Aug. 12, 2022 (HealthDay News) — Limiting access to non-vitamin K antagonist oral anticoagulants (NOACs) may exacerbate underuse of anticoagulants and increase the risk for adverse health outcomes, such as stroke, among patients with newly diagnosed atrial fibrillation, according to a study published online Aug. 4 in the American Journal of Managed Care.

Bo Zhou, Ph.D., from University of Southern California in Los Angeles, and colleagues identified a sample of Medicare beneficiaries with an incident diagnosis of atrial fibrillation (2011 to 2015) and followed them through 2016 or death. Anticoagulant use and health outcomes were compared by Medicare Part D plan coverage of NOACs.

The researchers found that beneficiaries enrolled in Part D plans that restricted access to NOACs had a lower probability of NOAC use, worse adherence conditional on NOAC use, and longer delays in filling an initial prescription within 30 days of atrial fibrillation diagnosis. Restricted plans were also associated with a higher aggregate risk for mortality, stroke, and transient ischemic attack (adjusted hazard ratio, 1.098).

“Insurers’ efforts to control health spending increasingly rely on restricting access to high-cost therapies. In the case of NOACs, these policies may be penny wise and pound foolish,” a coauthor said in a statement. “All pharmacy benefit managers and Medicare Part D plans need to continuously review their formulary policies to make sure that patients have timely access to effective medications.”

One author disclosed financial ties to the biotechnology industry.

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