Patients who received urgently needed medication immediately after artery-opening surgery had fewer heart attacks and rehospitalizations following their surgeries, according to a new study published on Oct. 23, 2008 in the New England Journal of Medicine.

Study author Cynthia A. Jackevicius, PharmD, Western University of Health Sciences Associate Professor for Pharmacy Practice and Administration, said the study found that adopting less restrictive health insurance policies for clopidogrel (trade name: Plavix) resulted in improved cardiovascular outcomes. Clopidogrel helps prevent blood clots.

"The restrictive drug policy we assessed in this study is called prior authorization, which is a commonly used strategy in American and Canadian drug plans to prevent unwarranted and excessive use of medications," Jackevicius said. "Our study provides some evidence for rethinking how medications are restricted in drug plans, suggesting that drug policies can impact patient outcomes."

The study, "Cardiovascular Outcomes after a Change in Prescription Policy for Clopidogrel," looks at the population-level effect of a change in a pharmacy benefits program in Ontario, Canada from a prior-authorization policy to a less restrictive, limited-use policy on access to clopidogrel among patients who underwent angioplasty with stenting after a heart attack.

Patients obtained their medication immediately upon hospital discharge with the less restrictive policy but waited an average of nine days to get their medication with the prior-authorization policy.

The rate of clopidogrel use within 30 days after hospital discharge following a heart attack increased from 35 percent in the prior-authorization period to 88 percent in the limited-use period.

The study looked at cardiovascular outcomes in 3,438 patients under the prior-authorization policy and 2,733 patients under the limited-use policy. The percentages of re-admission for heart attacks, additional surgery and death were reduced from 15 percent to 11 percent in changing to the limited-use policy. Re-admission for heart attacks within a year decreased from 5 percent to 3 percent.

"The methods for restricting urgently needed medications may need to be reconsidered in order to prevent unnecessary delays in receiving specific medications," Jackevicius said. "Some options include online approval, prescribing according to specific criteria, use only by authorized prescribers, or approving a short-term temporary supply that could then be assessed for prolonged use."

Cardiovascular Outcomes after a Change in Prescription Policy for Clopidogrel

Authors: Cynthia A. Jackevicius, Pharm.D., M.Sc., Jack V. Tu, M.D., Ph.D., Virginie Demers, M.D., Magda Melo, B.Sc.Phm., M.Sc., Jafna Cox, M.D., Stephane Rinfret, M.D., M.Sc., Dimitri Kalavrouziotis, M.D., M.Sc., Helen Johansen, Ph.D., Hassan Behlouli, Ph.D., Alice Newman, M.Sc., and Louise Pilote, M.D., M.P.H., Ph.D. New England Journal of Medicine. Volume 359:1802-1810. October 23, 2008. Number 13.

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About Western University of Health Sciences

Western University of Health Sciences (, located in Pomona, Calif., is an independent nonprofit health professions university, conferring degrees in health sciences, nursing, osteopathic medicine, pharmacy, physical therapy, physician assistant studies and veterinary medicine.