Managed care decision makers have a powerful tool that affects patient compliance with antihypertensive medications — the copayment level. This setting has associated clinical and economic consequences for the health plan. Researchers at the Hawaii Medical Service Association found that copayment level, independent of other determinants, was a strong predictor of compliance with antihypertensive medications, with greater compliance observed in patients filing pharmacy claims for drugs that required lower copayments, according to an article published in the American Journal of Managed Care.
Overall compliance for these agents was 66.8 percent in tier 1, 66.1 percent in tier 2, and 54.6 percent in tier 3. Angiotensin receptor blockers had the highest rate, whereas thiazide diuretics had the lowest. Groups that may need to be targeted because of low compliance include members under age 40, (42.5 percent compliance), Filipinos (58.7 percent), and HMO members (59.7 percent).
The researchers concede that observing a study population drawn from a single health plan in Hawaii means that conclusions may not be applicable to other populations. Medication compliance was determined indirectly from pharmacy claims.
The researchers recommend that patients be informed of their full range of options and of the copayment levels associated with each so that they can make cost-effective decisions that may lead to improved compliance and health outcomes.
As copayment goes up, compliance goes down
N/A indicates that the tier is unavailable for the therapeutic class
Source: Taira, DA, et al. Copayment level and compliance with antihypertensive medication: analysis and policy implications for managed care. Am J Manag Care. 2006;12:678–683