News and Commentary

High Copayments Delay Rx Initiation

Although many studies have established that high drug copayments discourage some patients from taking their medications, a new Rand study is the first to examine the effect of out-of-pocket costs on patients who are beginning drug therapy after being diagnosed with a chronic condition.

Patients diagnosed with hypertension, diabetes, or high cholesterol are significantly more likely to delay initiating recommended drug treatment if they face raised copayments for medications. This delay was greatest in patients who had not previously used prescription drugs to treat their chronic condition.

“Our study clearly shows that out-of-pocket costs reduce patients’ willingness to start treatment for their chronic illness,” says lead author Matthew D. Solomon, MD, an adjunct researcher at Rand. He says the findings are pertinent to insurers and policymakers who are interested in creating policies to improve medication compliance and raise the quality of care.

The study, published in the Archives of Internal Medicine, included 272,474 retirees who received health coverage from their former employers from 1997 to 2002 and were covered by 31 different health plans. Researchers focused on a sample of 17,183 people from this group who were newly diagnosed with diabetes, hypertension, or high cholesterol, examining their medical records to see when they began to fill prescriptions.

For each condition, patients who had high out-of-pocket costs were less likely to start prescription drug therapy compared to other patients in the study. For example, among those newly diagnosed with hypertension, the number starting drug treatment within a year of diagnosis dropped from 55 percent to 40 percent when the copayment doubled. After five years, the difference was 82 percent to 66 percent. Similar findings were presented for patients diagnosed for the first time with diabetes and high cholesterol.

The study also showed that patients who had no experience with medications were even less likely to begin recommended drug treatment, an indication that “some patients may have a preference against medication use.”

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