Rising Co-Payments Prompt Some to Forego Medications

Some have serious problems like diabetes, asthma, high blood pressure

TUESDAY, May 18, 2004 (HealthDayNews) -- Even if you have insurance, rising co-payments may make you feel that some prescription medications are just too expensive for you.

That's the conclusion of a new study, appearing in the May 19 issue of the Journal of the American Medical Association, that found that when co-payments were doubled the use of eight classes of prescription medicines dropped.

"In the last five to seven years, employers have dramatically shifted the cost of prescription drug spending to employees, which in and of itself is not a bad thing, but they're doing it in a way that could have adverse effects," said study co-author Geoffrey Joyce, an economist from Rand Corp. in Santa Monica, Calif.

Of particular concern, said Joyce, is that many people with diabetes, asthma, high blood pressure and high cholesterol stopped taking their medication when the price increased. These are serious health problems, and not taking essential medications could cause an increase in hospital visits and other health-care expenditures, possibly negating any prescription drug savings, the study found.

Joyce and his colleagues examined pharmacy and medical-claims records from 30 large U.S. employers from 1997 through 2000. More than 500,000 beneficiaries were included in the analysis. Co-payments ranged from $5.70 to $33.05.

Medications to reduce high blood pressure were the most commonly used drugs -- 22 percent of the sample members used them. Nineteen percent used non-steroidal anti-inflammatory medications (NSAIDs), while 17 percent were taking antihistamines. Twelve percent used antidepressants and 11 percent were taking medications to lower their cholesterol. Another 11 percent were taking anti-ulcerants to control ulcer symptoms or gastrointestinal reflux. Nine percent took asthma medications and 4 percent were on diabetes therapy.

The researchers said the medications could be broadly classified into three categories -- drugs that forestall disease progression and avoid complications (high blood pressure medication, antidiabetics, cholesterol-lowering drugs); medications that treat symptoms or intermittent conditions (NSAIDs, antihistamines), and drugs that do both (antidepressants, anti-ulcerants and anti-asthmatics).

When co-payments doubled, the largest drop in prescriptions occurred for NSAIDs and antihistamines, down 45 percent and 44 percent, respectively.

Cholesterol-lowering medication use dropped by 34 percent, while anti-ulcerant use was down 33 percent. Asthma medication use was down 32 percent, blood pressure medications were down 26 percent, and antidepressant use was down 26 percent. And 25 percent fewer diabetics filled their prescriptions (with the exclusion of insulin prescriptions), the study found.

People who were chronically ill and regularly visiting their doctors were less likely to forego their medication despite the cost.

The drop in medication use may have increased other costs, the study authors said. Hospital stays rose by 10 percent and trips to the emergency room increased 17 percent for people with diabetes, asthma and gastric acid diseases during the study period.

Joyce said a better way to reduce costs might be to look at what a particular class of medication does and if there are cheaper alternatives. For necessary and beneficial medications, such as diabetes drugs, it would make sense not to charge a high co-pay, Joyce said.

For medications such as NSAIDs, where effective and affordable alternatives are available over the counter, "injecting some type of cost-sharing and price sensitivity for those type of drugs is fine," he said.

James Walsh is senior editor of The Insurance Dictionary and Kids and Health Care. He called the trend toward rising co-payments "typical nickel and diming."

"It's an attempt to depress the demand for consumers asking for non-generic drugs because they saw an ad on TV," he said.

Walsh said if you're choosing a health plan, make sure you find out what the prescription drug co-payments are before deciding. Also, if you have a chronic condition, check the plan's formulary (their list of approved drugs) to make sure yours are on it.

More information

To learn more about choosing a health insurance plan, visit the Agency for Healthcare Research and Quality. For more on prescription drug insurance, visit the Alliance for Health Reform.

SOURCES: Geoffrey Joyce, Ph.D., economist, Rand Corp., Santa Monica, Calif.; James Walsh, senior editor, Silver Lake Publishing, Los Angeles; May 19, 2004, Journal of the American Medical Association
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