PURPOSE: Current neurohormonal blocking therapy for systolic heart failure (SHF) including both Ace inhibitors and beta blockers has greatly improved both morbidity and mortality as well as has reduced resource utilization. The usage of such therapy is highly recommended in the 2005 ACC/AHA guidelines for SHF and is presently the standard of care in SHF, unless contraindicated. Pharmaceutical-sponsored medication assistance programs (MAP) are one method that indigent patients may obtain such life-saving therapy. Presently, some indigent Medicare patients utilize these MAP’s to acquire their medications. However, with the current change-over to Medicare Part D, participation of these indigent Medicare patients in these MAP is potentially threatened, as is their access to life-saving therapies. We desired to quantitate the magnitude of Medicare Part D on our SHF disease management program (HFDMP) supplying care primarily to indigent patients.
METHODS: We reviewed our HFDMP database as well as hospital administrative data from January 2005 to December 2005 at LJ Chabert Medical Center, one of 8 safety-net Louisiana state hospitals. Admitted patients were identified via ICD-9 codes. SHF was defined as clinical heart failure and EF < 40%. Patients were cross-referenced for participation in Medicare, participation in the HFDMP and participation in the MAP.
RESULTS: Three hundred eighty-two patients with both SHF and Medicare were identified. Mean age is 66.7 years, mean EF 35.6%, 41% female, 36% African-American, 95% NYHA I, II & III. Ace inhibitor usage is 95% and beta blocker usage (> 95% carvediol) is 96%. Sixty-five percent of Medicare patients obtained their medications via the MAP. The median household income was $11,800 annually.
CONCLUSION: A majority of Medicare patients followed in the HFDMP receive their life-saving medications via MAP’s. Their median annual household income is very low.
CLINICAL IMPLICATIONS: In face of Medicare Part D payments and co-payments, a significant number of indigent SHF patients may no longer have access to such evidence-based medical therapies. Health policies governing Medicare Part D and MAP need to consider the needs of such indigent patients.
DISCLOSURE: Lee Arcement, None.