Analysis by Resolve to Save Lives and partners shows that removing patient copayments for anti-hypertensive medications reduces risk of heart attack, stroke, and hospitalization
JANUARY 31, 2025 – A new analysis underscores the life-saving potential of eliminating patient copayments for antihypertensive medications. The study provides evidence that eliminating out-of-pocket costs for these essential drugs improves adherence to the medications, improves blood pressure control, lowers the risk of heart attacks and strokes, and can reduce overall health care costs.
The analysis, published today in eClinicalMedicine, was authored by experts from Ethiopia’s Ministry of Health, Thailand’s International Health Policy Program, Bangladesh’s National Heart Foundation, and global health organization Resolve to Save Lives.
“Fees for blood pressure medicine increase the risk of heart attacks and strokes,” said Dr. Tom Frieden, President and CEO of Resolve to Save Lives and a co-author of the study. ” When patients have to pay for blood pressure medications – even small amounts – they often skip doses or stop treatment entirely. The evidence is clear: eliminating medication fees saves lives.”
The study synthesizes data from 31 peer-reviewed studies to evaluate trends, barriers, and enablers to medicine access across low- and middle-income countries (LMICs).
Hypertension, often referred to as the “silent killer,” is the leading cause of premature deaths globally, killing more people every year than any other condition. At most 20% of the 1.3 billion adults with hypertension have their condition under control. The study highlights that cost remains a significant barrier to treatment, particularly in LMICs, where 80% of hypertension-related deaths occur.
The analysis also underscores that successful implementation of free medication programs hinges on meticulous planning and long-term funding commitments. In many health systems, medication fees serve as a critical revenue source for facilities. Removing these fees requires alternative funding mechanisms and sustainable investments in primary health care to prevent medication shortages, guarantee uninterrupted access to essential medications, and ensure quality of care.
“The world has made significant progress against vaccine-preventable diseases, childhood diseases, tuberculosis, malaria, and HIV by making healthcare free to patients,” Dr. Viroj Tangcharoensathien, MD, PhD, senior author of the article, from the International Health Policy Program in Thailand, added. ” We have to seize the opportunity to save lives from hypertension by making blood pressure medication affordable by the government and free for all patients. Generic blood pressure medicines are safe, effective, inexpensive, and affordable.”
Findings from the study include:
- Even small copayments reduce medication adherence and increase the risk of heart attacks, strokes, and hospitalizations, according to more than a dozen articles reviewed in the analysis
- In one study reviewed, patients receiving free medications were more than twice as likely to achieve blood pressure control as those paying out-of-pocket
- Providing free medications can be a cost-saver, reducing hospitalizations and overall health system expenses.
“Access to life-saving medications should not depend on a patient’s ability to pay,” said Dr. Renu Garg, Senior Vice President of Cardiovascular Health at Resolve to Save Lives and study co-author. “Eliminating copayments for antihypertensive medications is a proven strategy that can be scaled up globally to prevent cardiovascular deaths. Without urgent action, deaths from hypertension are projected to increase to more than 14 million by 2050. Increasing global hypertension control rates to 50% could prevent between 76 and 130 million deaths over 35 years.”