ArticleJournal of the American Heart Association2026
Out-of-Pocket Costs and Antihypertensive Medication Use Among Veterans: A Natural Experiment.
Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- Patient out-of-pocket costs for antihypertensive single pill combination products with cost caps.Journal of human hypertension · 2026Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBlood pressure (BP) control remains suboptimal in the United States despite available low-cost antihypertensive medications. Even small out-of-pocket medication costs may contribute to adherence. We determined whether $0 versus >$0 out-of-pocket costs for antihypertensive medications is associated with differences in adherence, discontinuation, BP control, and cardiovascular outcomes.
methodsWe included veterans with newly diagnosed hypertension who initiated antihypertensive medication in the Veterans Health Administration from 2004 to 2022. A fuzzy regression discontinuity design with 2-stage residual inclusion leveraged differences in medication copay policy at a 50% service-connected disability threshold (≥50% service-connected disability: $0 out-of-pocket cost versus <50%: $8 monthly cost). Outcomes included 1-year medication nonadherence (proportion of days covered <80%), 1-year medication discontinuation (no medication in the final 90 days of the study year), 1-year BP control (systolic BP/diastolic BP <140/90 mm Hg and <130/80 mm Hg) and cardiovascular disease events (myocardial infarction, coronary revascularization, peripheral artery disease, or stroke).
resultsAmong 417 705 veterans (mean±SD age, 56 [13] years; 92% male; 61% non-Hispanic White), 296 432 (71%) had $0 out-of-pocket costs. Accounting for changes in eligibility for $0 copays at the 50% service-related disability threshold, $0 out-of-pocket costs were associated with lower odds of nonadherence (odds ratio [OR], 0.87 [95% CI, 0.81-0.94]) and medication discontinuation (OR, 0.77 [95% CI, 0.71-0.84]). One-year BP control <140/90 mm Hg or <130/80 mm Hg and cardiovascular disease events events were similar between groups.
conclusionsAmong veterans with newly diagnosed hypertension, modest out-of-pocket medication costs were associated with lower adherence and discontinuation. These findings can inform ongoing discussions regarding policy levers for improving hypertension outcomes.
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