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Prescription drug co-payments and cost-related medication underuse

Published online by Cambridge University Press:  01 January 2008

TODD H. WAGNER ,
MICHELE HEISLER  and
JOHN D. PIETTE
TODD H. WAGNER*
Affiliation:
Department of Veterans Affairs Health Economics Resource Center, Department of Health Research and Policy, Stanford University, USA
MICHELE HEISLER
Affiliation:
Department of Veterans Affairs Center for Practice Management and Outcomes Research, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
JOHN D. PIETTE
Affiliation:
Department of Veterans Affairs Center for Practice Management and Outcomes Research, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
*
*Correspondence to: Todd H. Wagner, VA Palo Alto, 795 Willow Rd. (MPD-152), Menlo Park, CA 94025, USA. Email: twagner@stanford.edu
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Abstract

Co-payments have been linked to the slowing growth in pharmaceutical spending over the last five years. However, patients with health problems frequently have difficulty affording their pharmacotherapy and fail to take their medication as prescribed. We examine the relationship between co-payment amounts and four types of cost-related underuse: taking fewer doses, postponing taking a medication, failing to fill a prescription at all, and taking medication less frequently than prescribed. We conducted a nationwide survey of US adults age 50 and over who take medication for a chronic condition. Participants provided information on 17 chronic conditions, medication they take for those conditions, and whether they underused any medication due to cost. We analyzed those who reported paying co-payments for their prescriptions (n = 2,869). Analysis involved multivariate logistic regression, with adjustments for survey weights and clustering. Our data show a strong positive association between co-payments and cost-related medication underuse. Although people differ in how they underuse medications, these behaviours are strongly associated with co-payment amount. Realigning the co-payments with cost-effectiveness data, also known as value-based insurance design, warrants further investigation.

Type
Articles
Information
Health Economics, Policy and Law , Volume 3 , Issue 1 , January 2008 , pp. 51 - 67
Copyright
Copyright © Cambridge University Press 2008

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References

Baker, L., Wagner, T. H., Singer, S. and Bundorf, M. K. (2003), ‘Use of the internet and e-mail for health care information: results from a national survey’, Journal of the American Medical Association, 289(18): 2400–2406.Google Scholar
Bhandari, A. and Wagner, T., (2006), ‘Self-reported utilization of health care services: improving measurement and accuracy’, Medical Care Research and Review, 63(2): 217–235.CrossRefGoogle ScholarPubMed
Catlin, A., Cowan, C., Heffler, S., and Washington, B., (2007), ‘National health spending in 2005: the slowdown continues’, Health Affairs (Millwood), 26(1): 142–153.Google Scholar
Choo, P. W., Rand, C. S., Inui, T. S., Lee, M. L., Cain, E., Cordeiro-Breault, M., Canning, C., and Platt, R., (1999), ‘Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy’, Medical Care, 37(9): 846–857.CrossRefGoogle ScholarPubMed
Evans, C. and Crawford, B., (1999), ‘Patient self-reports in pharmacoeconomic studies: their use and impact on study validity’, Pharmacoeconomics, 15(3): 241–256.CrossRefGoogle ScholarPubMed
Fendrick, A. M., Smith, D. G., Chernew, M. E., and Shah, S. N. (2001), ‘A benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition cost’, American Journal of Managed Care, 7(9): 861–867.Google Scholar
Goldman, D. P., Joyce, G. F., Escarce, J. J., Pace, J. E., Solomon, M. D., Laouri, M., Landsman, P. B., and Teutsch, S. M. (2004), ‘Pharmacy benefits and the use of drugs by the chronically ill’, Journal of the American Medical Association, 291(19): 2344–2350.CrossRefGoogle ScholarPubMed
Goldman, D. P., Joyce, G. F., and Karaca-Mandic, P. (2006), ‘Varying pharmacy benefits with clinical status: the case of cholesterol-lowering therapy’, American Journal of Managed Care, 12(1): 21–28.Google Scholar
Goldman, D. P. and Lakdawalla, D. (2002), ‘A new method for determining patient payments for outpatient drugs’, American Journal of Managed Care, 8(2): 125, 128, 130.Google ScholarPubMed
Harris, K. M. (2002), ‘Can high quality overcome consumer resistance to restricted provider access? Evidence from a health plan choice experiment’, Health Services Research, 37(3): 551–571.CrossRefGoogle ScholarPubMed
Heisler, M., Wagner, T. H., and Piette, J. D. (2004), ‘Clinician identification of chronically ill patients who have problems paying for prescription medications’, American Journal of the Medical Sciences, 116(11): 753–758.Google ScholarPubMed
Heisler, M., Wagner, T. H., and Piette, J. D. (2005), ‘Patient strategies to cope with high prescription medication costs: who is cutting back on necessities, increasing debt, or underusing medications?’, Journal of Behavioral Medicine, 28(1): 43–51.CrossRefGoogle ScholarPubMed
Hsu, J., Price, M., Huang, J., Brand, R., Fung, V., Hui, R., Fireman, B., Newhouse, J. P., and Selby, J. V. (2006), ‘Unintended consequences of caps on Medicare drug benefits’, New England Journal of Medicine, 354(22): 2349–2359.CrossRefGoogle ScholarPubMed
Huskamp, H. A., Deverka, P. A., Epstein, A. M., Epstein, R. S., McGuigan, K. A. and Frank, R. G. (2003), ‘The effect of incentive-based formularies on prescription-drug utilization and spending’, New England Journal of Medicine, 349(23): 2224–2232.CrossRefGoogle ScholarPubMed
Kleinke, J. D. (2004), ‘Access versus excess: value-based cost sharing for prescription drugs’, Health Affairs (Millwood), 23(1): 34–47.CrossRefGoogle ScholarPubMed
Melfi, C. A., Chawla, A. J., Croghan, T. W., Hanna, M. P., Kennedy, S., and Sredl, K. (1998), ‘The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression’, Archives of General Psychiatry, 55(12): 1128–1132.Google Scholar
MMWR (2000), ‘HIV-related knowledge and stigma–United States, 2000’, MMWR Morbidity and Mortality Weekly Report, 49(47): 1062–1064.Google Scholar
Mojtabai, R. and Olfson, M. (2003), ‘Medication costs, adherence, and health outcomes among Medicare beneficiaries’, Health Affairs (Millwood), 22(4): 220–229.CrossRefGoogle ScholarPubMed
Neumann, P. J., Lin, P. J., Greenberg, D., Berger, M., Teutsch, S., Mansley, E., Weinstein, M. C., and Rosen, A. B. (2006), ‘Do drug formulary policies reflect evidence of value?’, American Journal of Managed Care, 12(1): 30–36.Google Scholar
Piette, J. D., Heisler, M., Krein, S., and Kerr, E. A. (2005), ‘The role of patient–physician trust in moderating medication nonadherence due to cost pressures’, Archives of Internal Medicine, 165(15): 1749–1755.CrossRefGoogle ScholarPubMed
Piette, J. D., Heisler, M., and Wagner, T. H. (2004), ‘Cost-related medication underuse among chronically ill adults: the treatments people forgo, how often, and who is at risk’, American Journal of Public Health, 94(10): 1782–1787.Google Scholar
Piette, J. D., Heisler, M., and Wagner, T. H. (2004), ‘Cost-related medication underuse: do patients with chronic illnesses tell their doctors?’, Archives of Internal Medicine, 164(16): 1749–1755.CrossRefGoogle ScholarPubMed
Piette, J. D., Heisler, M., and Wagner, T. H. (2004), ‘Problems paying out-of-pocket medication costs among older adults with diabetes’, Diabetes Care, 27(2): 384–391.Google Scholar
Piette, J. D., Heisler, M., and Wagner, T. H. (2006), ‘Medication characteristics beyond cost alone influence decisions to underuse pharmacotherapy in response to financial pressures’, Journal of Clinical Epidemiology, 59(7): 739–746.CrossRefGoogle ScholarPubMed
Prescription drug trends (2004), Available from www.kff.org/rxdrugs/upload/Prescription-Drug-Trends-October-2004-UPDATE.pdf.Google Scholar
Roblin, D. W., Platt, R., Goodman, M. J., Hsu, J., Nelson, W. W., Smith, D. H., Andrade, S. E., and Soumerai, S. B. (2005), ‘Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much?’, Medical Care, 43(10): 951–959.CrossRefGoogle ScholarPubMed
Rosen, A. B. (2006), ‘Grounding coverage in value: a paradigm for linking quality and costs’, Medical Care, 44(5): 389–391.CrossRefGoogle ScholarPubMed
Soumerai, S. B., Avorn, J., Ross-Degnan, D., and Gortmaker, S. (1987), ‘Payment restrictions for prescription drugs under Medicaid: effects on therapy, cost, and equity’, New England Journal of Medicine, 317(9): 550–556.CrossRefGoogle Scholar
Soumerai, S. B., McLaughlin, T. J., Ross-Degnan, D., Casteris, C. S., and Bollini, P. (1994), ‘Effects of a limit on Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia’, New England Journal of Medicine, 331(10): 650–655.CrossRefGoogle ScholarPubMed
Soumerai, S. B., Ross-Degnan, D., Avorn, J., McLaughlin, T., and Choodnovskiy, I. (1991), ‘Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes’, New England Journal of Medicine, 325(15): 1072–1077.Google Scholar
Steiner, J. F. and Prochazka, A. V. (1997), ‘The assessment of refill compliance using pharmacy records: methods, validity, and applications’, Journal of Clinical Epidemiology, 50(1): 105–116.CrossRefGoogle ScholarPubMed
Steinman, M. A., Sands, L. P., and Covinsky, K. E. (2001), ‘Self-restriction of medications due to cost in seniors without prescription coverage’, Journal of General Internal Medicine, 16(12): 793–799.Google Scholar
Tamblyn, R., Laprise, R., Hanley, J. A., Abrahamowicz, M., Scott, S., Mayo, N., Hurley, J., Grad, R., Latimer, E., Perreault, R., McLeod, P., Huang, A., Larochelle, P., and Mallet, L. (2001), ‘Adverse events associated with prescription drug cost-sharing among poor and elderly persons’, Journal of the American Medical Association, 285(4): 421–429.Google Scholar
WareJ., Jr. J., Jr., Kosinski, M., and Keller, S. D. (1996), ‘A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity’, Medical Care, 34(3): 220–233.Google Scholar