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Veteran Co-Pay Increase Affected Medication Adherence

Adherence to lipid-lowering medications declined by almost 20 percent after co-pay increase in 2002

TUESDAY, Jan. 13 (HealthDay News) -- After the U.S. Department of Veterans Affairs (VA) increased 30-day prescription co-payments from $2 to $7 in February 2002, veterans' adherence to lipid-lowering medications significantly declined, according to a report released online Jan. 12 in advance of publication in an upcoming issue of Circulation: Journal of the American Heart Association.

Jalpa A. Doshi, Ph.D., of the University of Pennsylvania School of Medicine in Philadelphia, and colleagues analyzed the electronic records of 5,604 veterans receiving care at the Philadelphia VA Medical Center from November 1999 to April 2004.

During the post-increase period, the investigators found that adherence to lipid-lowering medications significantly declined among veterans who were responsible for all or some co-payments (-19.2 percent and -19.3 percent, respectively) but less significantly among veterans who were exempt from co-payments (-11.9 percent). They also found that the incidence of a continuous 90-day or more gap significantly increased among the all co-payment and some co-payment groups (24.6 percent and 24.1 percent, respectively), but increased less significantly among the co-payment-exempt group (11.7 percent). Similar declines were observed among subgroups at high risk for coronary heart disease, high medication users and elderly veterans, the researchers report.

"Our findings have several important implications for VA policy makers," the authors write. "First, price sensitivity varies across different populations, and small absolute changes in co-payments may still have a significant impact on medication use in populations with lower socioeconomic status, as had been reported previously with even a 50-cent co-payment increase among Medicaid patients. Hence, policy makers need to be cautious before implementing abrupt increases in co-payments within low-socioeconomic-status populations."

Several of the study authors disclosed receiving financial support from pharmaceutical companies.

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