JAMA
October 9, 2002
Employer Drug Benefit Plans and Spending on Prescription Drugs
By Geoffrey F. Joyce, PhD; José J. Escarce, MD, PhD; Matthew D. Solomon, MA;
Dana P. Goldman, PhD
We found that many of the tools used to influence pharmaceutical use were
effective in reducing drug expenditures for working-age enrollees with
employer-provided drug coverage. Adding an additional level of co-payment,
increasing existing co-payments or coinsurance rates, and requiring MGS
(paying co-payments plus differences in cost between the brand and generic
drugs) all reduced health insurance plan payments significantly.
Patient out-of-pocket spending did not change substantially within a
specific benefit design, because the reduction in overall drug use due to
higher patient cost-sharing largely offset the effects of higher co-payments
per prescription.
Several studies have found that spending caps and formulary restrictions
reduced use of both essential and nonessential medications among low-income
and elderly populations.
Conclusions: Adding an additional level of co-payment, increasing existing
co-payments or coinsurance rates, and requiring mandatory generic
substitution all reduced plan payments and overall drug spending among
working-age enrollees with employer-provided drug coverage. The reduction in
drug spending largely benefited health insurance plans because the
percentage of drug expenses beneficiaries paid out-of-pocket rose
significantly.
http://jama.ama-assn.org/issues/v288n14/abs/joc21507.html
Comment: We continue on the path of developing and expanding policies that
benefit health insurance plans, to the detriment of patient coverage. When
will we finally accept the concept that health policy should be designed to
benefit patients?