As drug co-pays rise, health may decline
Co-payments for prescription drugs may seem like a relatively minor expense; after all, many people must foot the entire bill for their medicine. But raising those payments, especially for folks who take several medications a day, can have a dramatic effect on even the privately insured.
Doubling out-of-pocket expenses for medications reduces the use of drugs for such chronic ailments as diabetes, asthma and ulcers by as much as 23%, researchers have found. In some cases, that decline can imperil a patient’s health.
“Employers who are trying to save money should be very careful about jacking up co-pays for certain illnesses,” said study author Dana P. Goldman, director of health economics at Rand Health in Santa Monica. “It may end up costing them more in the long run, because people will be spending more on ER visits and hospitalizations.”
By now, stories of fixed-income seniors who must choose between food and expensive medications have been told many times. So, too, have the stories of the uninsured who may simply go without medications. But Rand Corp. researchers focused on what happens when medication bills go up for working-age consumers with prescription benefits. Those bills have risen as employers have asked their workers to shoulder more of their healthcare costs.
The researchers analyzed pharmacy and medical claims from 1997 to 2000 for 30 large employers that insured more than half a million people through 52 health plans. They reviewed the effects of higher co-payments for drugs in the eight most widely prescribed drug classes. Overall, they found the greatest reductions in use among the non-steroidal anti-inflammatories, 45%, and antihistamines, 44%. But these drugs, which relieve symptoms instead of underlying illness, are taken only occasionally, and some of the drop might be explained by patients switching to cheaper, over-the-counter versions. Reductions in other classes could be partly explained by patients stopping medications that might not be essential.
But researchers were most concerned about potential health consequences among patients diagnosed with such chronic illnesses as diabetes, asthma, ulcers or gastrointestinal reflux disease, high cholesterol, high blood pressure and depression -- patients whose health is most likely to improve with prescription therapy. For those patients, cutting back or cutting out daily medications could have some of the most dire consequences.
Among Type 2 diabetics who depend on oral medications, such as metformin (Glucophage), rosiglitazone (Avandia) or glyburide (Micronase) to control blood sugar, medication use fell by 23%. Such patients might have skipped pills, not filled prescriptions or gone off the medications, Goldman said.
The researchers analyzed the consequences of doubling average co-payments in a typical two-tiered plan, from $6.31 to $12.62 for a months’ suply of a generic drug and from $12.85 to $25.70 for a month’s supply of a brand-name drug.
Reporting in the current issue of the Journal of the American Medical Assn., the researchers also offered preliminary indications that as drug use declined, patient health followed. Among those with diabetes, asthma and stomach acid disorders, visits to emergency rooms increased 17% and hospital stays rose 10%.
“It’s an extremely important study,” said Dr. Don Berwick, chief executive of the Institute for Healthcare Improvement, a nonprofit organization based in Boston. While pursuing better care at lower cost is a rational goal, he said, the Rand research suggests that “the consequence of putting more financial responsibility on patients is that they may get sicker.” Despite a public focus on the uninsured, “there’s quite a large band of people who are underinsured: there’s a mismatch between their needs and their disposable income.”
The study was sponsored by the California HealthCare Foundation, with additional money from pharmaceutical giant Merck & Co., and the U.S. Agency for Healthcare Research and Quality.
