Rising pharmacy copays could lead to health risk
A Johns Hopkins University researcher warns that efforts to control pharmacy costs by increasing patient copays can have an unintended health consequence — people aren’t as likely to fill their prescriptions. The ultimate result could be higher health care costs if those patients become sicker and need more intensive care.
Donald Steinwachs, chairman of the Department of Health Policy and Management in the Bloomberg School of Public Health at Johns Hopkins in Baltimore, wrote an editorial in the Journal of the American Medical Association responding to a study that showed that employer insurance costs can be reduced substantially by increasing employees’ out-of-pocket costs. "The findings consistently show that employer costs decline as the patient’s out-of-pocket costs increase with higher copayments, both in single-tier and multitier plans," he says.
The study Mr. Steinwachs responded to was funded by the California HealthCare Foundation and conducted by Geoffrey Joyce, a Rand economist, who analyzed the health coverage of 421,000 workers employed by 25 large private companies from 1997 to 1999.
The study found that increasing copays for prescription drugs led some employees to buy generic drugs instead of branded products, while others switched to over-the-counter treatments.
The study also found that as copayments become larger, patients fill fewer prescriptions and pay a larger proportion of total drug costs. "As copayments increased, individuals filling any prescription during a year declined modestly (78% to 74.3%), although the average number of prescriptions filled declined substantially by more than 30%," Mr. Joyce writes.
Mr. Steinwachs says the results raise "an important public health concern" that can’t be ignored. There is limited research, he says, on the health consequences of not taking prescribed medications because they are not affordable.
Most of the research that is available is from the public sector, and relates to changes in coverage policy. In a Canadian study, for example, when drug copayments and coinsurance were introduced, there were fewer prescriptions filled both with medications classified as essential, such as insulin, and those classified as nonessential. In addition, rates of serious adverse events and emergency department visits associated with reductions in use of essential drugs increased significantly.
"The rapidly escalating costs for drugs make ensuring adequate prescription drug coverage more critical, especially for drugs essential for the care of chronic health problems. Comparisons made between Medicare beneficiaries with and without drug coverage shows those in poor health with no drug coverage fill 36% fewer prescriptions than those with coverage, and those with incomes below the poverty line and without coverage fill 48% fewer prescriptions than those with coverage. Other studies have shown the negative effects of reducing drug coverage among poor elderly patients and the consequences of inadequate drug coverage for elderly patients receiving medications that can prevent serious adverse health consequences," Mr. Steinwachs writes.
He also reports that although the driving force behind multitiered pharmacy benefit plans and higher copayments is cost control, there is no evidence that changing to a two-tier or three-tier drug coverage plan or imposing higher copayments or coinsurance levels has any impact on the rate of increase in prescription costs over time.
Families USA executive director Ron Pollack agreed with Mr. Steinwachs that caution is needed, saying, "There is abundant evidence how increased copayments, especially for lower-income employees, can have an adverse impact on the care they need, including prescription drugs."
According to Diane Rowland, executive vice president for the Kaiser Family Foundation, there is concern that people "won’t fill prescriptions because of the cost, or they will stretch their medications by breaking pills in half and not taking full doses of liquid drugs. "We certainly need more study into the impact of increased copayments, but it’s clear that those who make the least can least afford co-pays that can be as high a $20 or $30. People still might get an antibiotic if they need one, but they might forgo medication for chronic and ongoing conditions."
[Download the editorial from jama.ama-assn.org/issues/current/ffull/jed20058.html.]
A Johns Hopkins University researcher warns that efforts to control pharmacy costs by increasing patient copays can have an unintended health consequence people arent as likely to fill their prescriptions.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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