Cost of medications for patients with ischemic heart disease in a rural family practice center.

BACKGROUND Cardiovascular disease is the leading cause of death, and multiple medications are often needed to control symptoms and risk factors. Little research has explored the cost of medications for a typical patient with chronic ischemic heart disease. We undertook a study to determine the cost of medications and how they are paid for by patients in one rural clinic. METHODS One hundred four patients met criteria for chronic ischemic heart disease. We obtained patient information, risk factors, and current medications using retrospective chart reviews. We then calculated usual and customary costs per month for each of the 355 cardiac and 214 noncardiac prescriptions. After we determined which patients qualified for third party reimbursement or the community health center medication discount program, we calculated the actual out-of-pocket cost to the patient for each prescription. RESULTS Average monthly medication costs were $104.77 for cardiac medications and $115.54 for noncardiac medications, for a total of $220.31. Patients were reimbursed for approximately 64 percent of the total medications costs, making average out-of-pocket medication costs $41.52 for cardiac medications and $36.86 for noncardiac medications, for a total of $78.38. Seventy-one percent of patients were reimbursed by their insurance company, 19 percent qualified for the medication discount program, and 10 percent had no assistance. Patient risk factors included positive family history of chronic ischemic heart disease (71 percent), hypertension (64 percent), history of smoking (61 percent), currently smoking (26 percent), diabetes (25 percent), and recently elevated cholesterol levels (67 percent of 76 patients). CONCLUSIONS Medication costs for patients with chronic ischemic heart disease are expensive and burdensome. Third party payers and the medication discount program relieved a considerable (64 percent) but inadequate amount of prescription costs. Multiple risk factors coexist with these medication costs. Patient behavior modification and an aggressive approach to risk reduction might reduce these costs.