The news story, Study: Drug Caps Mean Sicker Patients, No Savings,
summarizes research at Kaiser Permanente published in the New England Journal of Medicine which reviewed 200,000 patients who had Medicare+Choice coverage (now called Medicare Advantage) in 2003. One-fifth of the patients had unlimited drug coverage; the rest had a $1,000 annual drug benefits cap.

In contrast to the predicted savings from more judicious management of healthcare by individuals who would be responsible for a portion of its cost, patients who hit the cap stopped taking their medications, were more likely to get sick, and required more treatment.

“Although there were lower drug costs, the higher costs for hospitalizations and emergency-department visits offset those savings,” concluded study author Dr. John Hsu, “This study showed that a $1,000 drug-benefit cap had consistent unfavorable health effects — and failed to save money.”

Commentary

This is yet another bit of evidence supporting the notion that the entire healthcare system, including patients and third party payment schedules, must be in alignment for compliance to improve.

• Drug Courts
• Promoting Compliance With Pharmacy Benefit Incentives
• Noncompliance Despite Life Or Death Stakes
• Strategies To Increase Adherence To Antabuse
• Results Of Differing Methods Of Communicating Treatment Benefits To Patients