Pharmacy Benefits and the Use of Drugs by the Chronically Ill
RAND study on drug co-payments
JAMA
May 19, 2004
Pharmacy Benefits and the Use of Drugs by the Chronically Ill
By Dana P. Goldman, PhD, et al
Objective: To determine how changes in cost sharing affect use of the most commonly used drug classes among the privately insured and the chronically ill.
Results: Doubling co-payments was associated with reductions in use of 8 therapeutic classes. The largest decreases occurred for nonsteroidal anti-inflammatory drugs (NSAIDs) (45%) and antihistamines (44%).
Reductions
in overall days supplied of antihyperlipidemics (34%), antiulcerants (33%),
antiasthmatics (32%), antihypertensives (26%), antidepressants (26%), and
antidiabetics (25%) were also observed. Among patients diagnosed as having a
chronic illness and receiving ongoing care, use was less responsive to co-payment changes. Use of antidepressants by depressed patients declined by
8%; use of antihypertensives by hypertensive patients decreased by 10%. Larger reductions were observed for arthritis patients taking NSAIDs (27%) and allergy patients taking antihistamines (31%). Patients with diabetes reduced their use of antidiabetes drugs by 23%.
Conclusions: The use of medications such as antihistamines and NSAIDs, which are taken intermittently to treat symptoms, was sensitive to co-payment changes. Other medications-antihypertensive, antiasthmatic, antidepressant, antihyperlipidemic, antiulcerant, and antidiabetic agents-also demonstrated significant price responsiveness. The reduction in use of medications for individuals in ongoing care was more modest. Still, significant increases in co-payments raise concern about adverse health consequences because of the large price effects, especially among diabetic patients.
RAND is solely responsible for the article’s content.
http://jama.ama-assn.org/cgi/content/abstract/291/19/2344
Comment: A previous RAND study demonstrated that cost sharing by the patient results in a significant reduction in utilization of health care services when compared with patients who do not have cost sharing.
That RAND study has been used to rationalize shifting more costs to patients in an attempt to control total health care costs by reducing demand. Further analysis of the RAND data has shown that this does reduce the utilization of beneficial services. Advocates of consumer-directed health care use their rhetoric to turn this problem of establishing financial barriers to beneficial care into a “benefit” of allowing the consumer to take charge of his or her own health care. More objective advocates of cost sharing dismiss it as a necessary tradeoff for the “more important” goal of controlling costs.
This new RAND study confirms that individuals with chronic disorders will decrease their use of drugs when co-payments are increased. The reduction is
even greater for drugs that do not specifically treat their chronic conditions but that are used to relieve distressing symptoms. Although some may contend that these drugs are unimportant, symptom relief does remain a primary goal of health care.
This study will be misrepresented in the rhetorical debate over reform. Supporters of creating price sensitivity for patients will laud this study. They will contend that co-payments cause patients to reject unnecessary prescriptions while continuing to purchase those medications that they really need. In our debates we will be confronted with this claim. We will need to either take the initiative or rephrase their misleading claim by stating that co-payments reduce the utilization of essential drugs for chronic conditions, and they reduce even more the use of drugs that can provide significant relief of pain and suffering!
There are far more effective and patient-friendly mechanisms of containing health care costs. We don’t need to adopt policies that would perpetuate pain and suffering, especially for those patients with the greatest needs.