Analysis: As co-pay rises, drugs use drops

WEST PALM BEACH, Fla., July 3 (UPI) -- Attempts to get consumers in prescription drug plans to pay more for their pills appears to result in less use of medications -- and more use of more expensive hospitalization and emergency department services, U.S. researchers said Tuesday.

Dana Goldman, director of the RAND Health's Bing Center on Heath Economics in Santa Monica, Calif., said, "Increased cost-sharing is associated with lower rates of drug treatment, worse adherence among existing users and more frequent discontinuation of therapy."

Reporting in Wednesday's issue of the Journal of the American Medical Association, Goldman said his research indicates that in patients with chronic health problems such as heart disease, diabetes or mental health illnesses, less use of pharmaceuticals increases the use of more expensive medical services.

In a review of 132 articles in the medical literature, Goldman said he found that for every 10-percent increase in spending demanded of the consumer for pharmaceuticals, there is a 2-percent to 6-percent decrease in overall pharmacy spending.

He said that for patients with chronic conditions, higher cost-sharing is associated with increased use of medical services. That includes patients with congestive heart failure, high cholesterol, diabetes and schizophrenia.

"The findings from studies focusing solely on the chronically ill are unambiguous," Goldman said. "Greater use of inpatient and emergency medical services are associated with higher co-payments or cost-sharing for prescription drugs."

Goldman noted that the pharmaceutical advances over the past generation have had a dramatic impact on the practice of medicine in the United States. "More and better quality drugs are available to prevent and manage chronic illness," he said, "and these drugs reduce mortality, forestall complications and make patients more productive. Thus, access to outpatient drugs is now a cornerstone of an efficient healthcare system."

However, these improved drugs also cost more and health benefit plans are attempted to make consumers make up the differences in costs. Goldman said some studies found no change in patient outcomes with increases in co-pays, but studies that looked at how co-pay impacted lower socio-economic groups and patients with chronic illnesses found differences.

The researchers analyzed how cost-sharing features of prescription drug benefits affected access to prescription drugs and how these features affected medical spending and health outcomes. They examined articles that were published from 1985 to 2006.

They particularly examined the associations between prescription drug plan cost-containment measures, including co-payments, co-insurance and monthly prescription limits, and outcomes.

"These findings make benefit design an important public health tool for improving population health," Goldman said. "The challenge for public and private plans is to make patients more sensitive to the cost of treatment without encouraging them to forego cost-effective care."