Newswise — 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 industry.
"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 DRUGSMedication 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 percent.
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 cost-sharing.
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 CareRated 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.
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