Higher Costs Mean Fewer Take Lifesaving Drugs

Study finds use of statins drops sharply when co-pays rise

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HealthDay Reporter

TUESDAY, June 8, 2004 (HealthDayNews) -- Many patients are not taking cholesterol-lowering drugs even though they can help prevent a second heart attack or stroke, and high insurance co-pays are the main reason why, researchers report.

The study found that almost half of patients who had prescriptions for the drugs, called statins, did not take them often enough or stopped taking them. The report appears in the June issue of the Journal of General Internal Medicine.

"Patients' adherences to statin therapy is much less than we would like to see it," said Dr. James Stevenson, director of pharmacy services at the University of Michigan Health Services.

"People don't take the drugs regularly and discontinue therapy at a rapid rate," he added. "Since these are drugs that are known to improve survival in patients with cardiovascular disease, this is not a good thing. There will be increased mortality and disease."

In addition, Stevenson's group compared people who had had a heart attack or stroke to patients who had had neither. Surprisingly, they found those who had had a heart attack or stroke were just as likely not to take their statins as those who didn't suffer either ailment.

To come to their conclusions, the research team collected data from the insurance records of 4,802 patients.

"The amount of the patient's co-pay was a clear predictor of poor compliance," said study co-author Dr. A. Mark Fendrick, a professor of internal medicine and health policy at the University of Michigan. "As the amount of money that you had to pay to fill your cholesterol-lowering drug went up, the likelihood of you staying on it went down substantially."

Among patients whose co-pay was less than $10 a month, 50 percent remained on the drug after four years; in contrast, 50 percent of patients whose monthly co-pay was more than $20 stayed on their statin for only one year.

"This confirms that the amount of money that people actually have to pay for their drugs out of pocket, even if they have pharmacy benefits, is a critical aspect of getting drugs to people who need them," Fendrick said.

Fendrick believes that one way to solve this problem is to lower or eliminate co-pays for patients who have had a heart attack or stroke. This might help insure that these patients, who are most at risk for another event, will continue to take their medication. Statins, he noted, have a proven benefit in preventing a second event.

"As opposed to drug discount cards or expanding benefits, we need to identify the people who need the medication most and provide the financial incentives to insure they take their medicine as prescribed," Fendrick said.

"The really interesting part of the study is the inverse relationship between patient co-payment and medication adherence," said Dr. Michael Fischer from the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital in Boston.

"While many people intuitively suspect that this sort of behavior is going on, it's important to demonstrate that it occurs. Hopefully, it will further the debate about the best ways to structure prescription drug reimbursement plans; anything that decreases patient adherence to statins represents a clinical problem," Fischer added.

"If one could eliminate risk factors that cause heart attacks and strokes, then billions of dollars and hundreds of thousands of lives would be saved," said Dr. Lawrence M. Brass, a professor of neurology at Yale University School of Medicine.

Brass added that, each year, 20 percent of those who have had a heart attack or stroke suffer another one, and 20 percent of them die. After five years, fewer than 20 percent of patients haven't had a repeat attack.

"That's terrible," he said. "And that's in a country where we spend $1.4 trillion per year on health, and we don't do better than countries that spend half that."

Lowering co-pays could have an impact on the first- and third-leading killers (heart attack and stroke), Brass said. "If people aren't taking the drugs because of $10 a month, that is a problem."

"We end up paying for this," he added. "The patient may not, but when they get re-hospitalized, then Medicare or their HMO absorbs those costs."

Statins, Brass noted, are "very cost-effective medicines. Forget about the fact that you're saving lives and improving the quality of peoples' lives. It's cheaper to prevent disease than to treat it."

More information

The American Heart Association can tell you about statins.

SOURCES: James Stevenson, Pharm.D., director, pharmacy services, University of Michigan Health Services, Ann Arbor; A. Mark Fendrick, M.D., professor, internal medicine and health policy, University of Michigan, Ann Arbor; Lawrence M. Brass, M.D., professor, neurology, Yale University School of Medicine, New Haven, Conn.; Michael Fischer, M.D., Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston; June 8, 2004, Journal of General Internal Medicine

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