Impact of Cost-Sharing on Self-Measured Blood Pressure: Cost and Prescription Abandonment for Home BP Monitors in a Large FQHC

Abstract

Background: Self-measured blood pressure is an important tool for diagnosing and controlling hypertension. Current insurance coverage for home blood pressure monitors varies widely, creating potential barriers to implementation.

Methods: This observational study was conducted in a large, multisite Federally Qualified Health Center in Tucson, AZ, between 2023 and 2024. We compared prescription rates and fill rates during two 6-month periods: the final six months of grant-funded free monitor distribution (2023, n = 2,619 prescriptions, 2,357 fills) vs. the first 6 months after grant end when patients were charged approximately $35 (2024, n = 1,630 prescriptions, 974 fills). Data were extracted from the electronic health records system and analyzed using R version 4.2.3.

Results: After cost-sharing implementation, two distinct effects reduced monitor distribution: prescription fill rates decreased from 90.0% to 59.8% (30.2% reduction, 95% CI [27.8%, 32.2%]), and providers sent 38% fewer prescriptions. The combined effect of both reduced prescribing and lower fill rates resulted in 59% fewer patients receiving monitors (974 vs. 2,357).

Conclusions: In this single-center study, cost-sharing was associated with substantial reductions in both prescribing and filling of home BP monitor prescriptions.

Keywords: blood pressure; blood pressure monitors; cost-sharing; hypertension; prescription abandonment; self-measured blood pressure.