Medical News Today, 25 Jun 2008
Adding even minimal copayments to Medicaid prescription drug plans
leads to reductions in medication use by patients with chronic
diseases, reports a study in the June issue of Medical Care.
The journal is published by Lippincott Williams & Wilkins, a part
of Wolters Kluwer Health, a leading provider of information and
business intelligence for students, professionals, and institutions in
medicine, nursing, allied health, pharmacy and the pharmaceutical
“Subjects with chronic diseases were less likely to reduce the use of
drugs used for that disease compared with drugs not for that disease,”
according to the study, led by Daniel M. Hartung, Pharm.D., M.P.H., of
Oregon Health & Science University, Portland.
Dr. Hartung and colleagues analyzed the impact of a recent cost-sharing
program on medication use by Oregon Medicaid enrollees. Starting in
2003, small copayments $2 for generic and $3 for brand-name medications
were set for prescription drugs. The copays were not required for
patients who were unable to pay.
The researchers looked at changes in prescription drug use for patients
with depression, schizophrenia, respiratory disease, cardiovascular
disease, and diabetes all serious chronic illnesses in which not taking
prescribed medications could expose patients to unnecessary harm. The
analysis included pharmacy claims data on approximately 117,000
Medicare enrollees with these conditions.
With adjustment for other factors, overall use of prescription drugs
fell by about 17 percent after the start of the copay policy. The drop
occurred immediately after the copayments were implemented and did not
increase over time.
Copayments for some outpatient services were added at the same time.
However, there were no significant changes in the use of those
services, including doctor’s office visits, emergency department
visits, and hospitalizations.
IMPACT VARIED FOR DIFFERENT DISEASES, DIFFERENT DRUGS
Medication use decreased in all five chronic disease groups, but the
impact varied for different types of drugs. For example, for patients
with diabetes, there was no change in the use of diabetes-related
drugs, but use of other types of drugs decreased by 12 percent.
Similarly, patients with schizophrenia did not reduce their use of
antipsychotic drugs, but use of other types of drugs decreased by 15
Decreased use of antidepressants by patients with depression may have
been accompanied by a small increase in office visits. Overall, the use
of cardiovascular medications decreased the least, while the use of
drugs for depression and respiratory disease decreased the most.
Most state Medicaid programs now use copayments to help control
prescription drug costs. Despite the widespread use of copay policies,
surprisingly few studies have looked at how they affect medication use
especially for vulnerable populations of patients with disabilities and
chronic diseases. In response to the 2005 Deficit Reduction Act,
Medicaid programs are considering even more aggressive levels of
The new results show an immediate and substantial reduction in
medication use after the implementation of nominal copays in the Oregon
Medicaid program. “This study suggests that in response to cost-sharing
patients discriminate what therapies they reduce based on the diseases
they have,” the researchers write.
The few previous studies of this issue have also found reductions in
medication use in response to cost-sharing measures. This suggests that
“a more nuanced approach to crafting cost-sharing policies” should be
considered, Dr. Hartung and colleagues believe for example, eliminating
copays for drugs with strong evidence of effectiveness. The results may
also have implications for state Medicaid programs considering changes
to their copay programs under the Deficit Reduction Act, as well as for
Medicare Part D prescription drug plans.
About Medical Care
Rated as one of the top ten journals in healthcare administration, Medical Care
is devoted to all aspects of the administration and delivery of
healthcare. This scholarly journal publishes original, peer-reviewed
papers documenting the most current developments in the rapidly
changing field of healthcare. Medical Care provides timely reports on
the findings of original investigations into issues related to the
research, planning, organization, financing, provision, and evaluation
of health services. In addition, numerous special supplementary issues
that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association. Visit the journal website at http://www.lww-medicalcare.com.