2002_11 | NEWS: Copayments, outcomes hard to link, says study

MANAGED CARE EXECUTIVE EDITION November 2002. ©MediMedia USA

NEWS AND COMMENTARY

Copayments, outcomes hard to link, says study

Prescription drug copayments in a tiered formulary are an effective way for HMOs to control costs, although they do sometimes influence workers to go without medications for non-life-threatening conditions, according to a recent study.

A paper in the Oct. 9 issue of the Journal of the American Medical Association found that when plans raise copayments, one of the ways enrollees react is by not filling their prescriptions.

The authors analyzed the coverage of 421,000 workers from 1997 to 1999, and found that employees also tend to rely more on generic drugs when introduced to a tiered pharmacy benefit.

While the study does not directly address whether workers' health suffered as a result of such maneuvering, lead author Geoffrey Joyce tells the Washington Post that most of the medications skipped because of higher copayments were for allergies and arthritis. Authors say that the increase in drug spending from 1987 to 1993 occurred due to both rising drug prices and higher per-capita utilization.

"However, since 1994, the growth in spending has been largely due to increased utilization," they add. "If this trend continues, increased patient cost-sharing will play a larger role in reducing the level of drug spending than slowing the growth in expenditures."

The study generated immediate feedback.

"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," says Ron Pollack, executive director of Families USA, a consumer advocacy group.

The study's authors, however, say that more research will need to be done before a link between copayments and outcomes can be determined.

"There is little evidence about whether lower pharmaceutical use resulting from higher patient cost-sharing adversely affects clinical outcomes," say the authors. Several studies, they note, have linked spending caps and formulary restrictions to reduced use of essential and nonessential medications in low-income and elderly populations.

"However, few studies have found a consistent link between higher copayments and patients' health, particularly among persons with employer-sponsored coverage whose drug spending comprises a much smaller percentage of their income."