Increases in Drug Co-payments May Reduce Patients ¹ Use of Medications Libraries

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Increases in Drug Co-payments May Reduce Patients¹ Use of Medications

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PRESCRIPTION DRUG CO-PAYMENT PHARMACY COST BENEFITS CHRONIC ILLNESS

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Increasing patients¹ co-payments for prescription medications leads to

decreases in their use of eight classes of therapeutic drugs, according to a

new study co-funded by AHRQ.

Newswise ‹ Increasing patients¹ co-payments for prescription medications led

to decreases in their use of eight classes of therapeutic drugs, according

to a new study co-funded by the Agency for Healthcare Research and Quality.

Researchers linked pharmacy claims data representing nearly 530,000 people

age 18 to 64, who all had employer-sponsored health insurance, with health

benefit designs from 52 private health plans and 30 employers. The study

included one-tier, two-tier, three-tier, and coinsurance drug benefit plans

included in the study of all types. The simulated co-payment increases were

relevant for all plans but were calibrated to two-tier plans. The analysis

followed study subjects for nearly 4 years.

Based on this analysis, researchers estimated that doubling co-payments in a

typical two-tier drug plan resulted in an approximately 45 percent reduction

in the use of anti-inflammatory drugs and antihistamines, a drop of

approximately 35 percent in the use of cholesterol-lowering medications and

drugs to treat ulcers and asthma, and a decrease of about 25 percent in the

use of medicines used to treat high blood pressure, depression, and

diabetes.

The rate of decrease depended on whether patients were taking the drug on an

ongoing or intermittent basis. Patients with chronic illnesses were less

likely to cut back or stop taking the medications needed to treat their

conditions when drug co-payments increased; however, they seemed to reduce

their use of other medications. For example, the study found that patients

with depression cut their use of most drugs by 25 percent but reduced their

use of antidepressants by only 8 percent when their co-payments doubled.

Similarly, patients with high blood pressure cut their use of

antihypertensives by only 10 percent but reduced their use of all other

drugs by 27 percent.

Researchers also found preliminary evidence that patient health suffers as

individuals with some chronic illnesses cut back on their medicines. For

example, as the use of prescription drugs declined, visits to hospital

emergency rooms increased 17 percent and hospital stays rose by 10 percent

among patients with diabetes, asthma, and gastric acid diseases.

³This study will give public and private policymakers rigorous science-based

information to evaluate the impact that changes in cost sharing can have on

patients¹ use of medications,² said Carolyn M. Clancy, M.D., AHRQ¹s

director. ³The article¹s findings suggest that policy solutions to reducing

costs while maintaining quality cannot be 'one-size fits all' solutions, but

must take into account the potential response of patients.²

The research team was led by Drs. Dana P. Goldman and Geoffrey F. Joyce and

their colleagues at the RAND Corporation in Santa , CA, as well as by

co-authors from Merck and California Healthcare Foundation. Both

organizations also co-funded the study. Details are in ³Pharmacy Benefits

and the Use of Drugs by the Chronically Ill,² published in the May 19, 2004,

issue of the Journal of the American Medical Association.