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Healthcare Cost-sharing And Medication Compliance

July 10th, 2007 at 6:12 pm · Allan Showalter, MD · Clinical Info · No Comments

Prescription Drug Cost Sharing – Associations With Medication and Medical Utilization and Spending and Health by Dana P. Goldman, PhD; Geoffrey F. Joyce, PhD; Yuhui Zheng, MPhil, JAMA. 2007;298:61-69. July 4, 2007

The Study

To study the relationship between cost-sharing and patient compliance, researchers reviewed 132 articles, published between 1985 and 2006 examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n = 65), pharmacy benefit caps or monthly prescription limits (n = 11), formulary restrictions (n = 41), and reference pricing (n = 16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes.

Results, as excerpted from the abstract, show the following:

Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention.

Commentary

There is little that is surprising in the findings. And, while the formula offered, For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient, may well oversimplify the connection between medication use and cost-sharing, it is a starting point for quantifying the economics of medication compliance and medication cost.

Tags: Clinical Info