When employees suddenly have to pay a lot extra for brand-name medications, a disturbing number of them simply stop taking their blood pressure and cholesterol pills, instead of switching to cheaper varieties, research shows. A study conducted by Harvard Medical School and Medco examined the effects of higher copayments on workers when companies switch to three-tier prescription drug plans that encourage generic prescriptions or cheaper medicines.
More and more employers have been adopting three-level pricing plans, which are designed to encourage employees to use generics or other less expensive drugs. Those who want to use pricier drugs have to pay the highest out-of-pocket expenses.
In a study of two such plans, as many as half of the employees changed from an expensive drug to a cheaper one when their benefits switched to three tiers. But many others quit getting their prescriptions for chronic conditions.
While researchers said they do not know exactly why the employees gave up their drugs and what effect that had on their health, “it is worrisome to see that people have stopped taking their medication,” said one of the researchers, Dr. Patricia Deverka of Medco Health Solutions, the nation’s largest pharmacy benefit-management company.
The study was conducted by researchers at Harvard Medical School and Medco and was reported in Thursday’s New England Journal of Medicine.
Nearly all employer-provided insurance plans offer workers some kind of prescription drug benefit, and 63 percent of those employees are now in three-tier plans, up from 27 percent in 2000, according to the nonprofit Kaiser Family Foundation. The newly passed Medicare legislation allows for the use of tiered pricing for its prescription drug benefit.
Under the plans, employees pay the lowest copayment for generic drugs, a higher amount for brand-name drugs on a preferred list, and the highest amount for other brand-name medicines.
The first employer, with 55,500 hourly workers, went from a $7 copayment for all prescriptions to $8 for generics, $15 for preferred brand names and $30 for third-tier brand names. The second employer, with 11,600 salaried workers, had a less dramatic change, adding a third level of $24 for brand names to its two-level plan of $6 for generics and $12 for preferred brand names.
The researchers also looked at similar plans at other companies to see what happens when no changes in copayments occur.
Only in the first employer group were workers more likely to quit taking their top-tier drugs when the copayment jumped. About 16 percent stopped taking their ACE inhibitors compared with 6 percent in the comparison group, 21 percent stopped statins compared with 11 percent, and 32 percent dropped acid reflux drugs compared with 19 percent.
Harvard researcher Haiden Huskamp said it is possible that some of the workers filled their prescriptions through a spouse’s health plan or, in the case of acid reflux drugs, the medication may no longer have been necessary.
Many of the workers in both employer groups did switch to lower-priced drugs, ranging from 18 percent for acid reflux drugs to 49 percent for statins.
Total spending under each plan did not change much. In the first employer group, the health plan itself had substantial savings, since more of the cost was shifted to the employees.
Cindy Parks Thomas of Brandeis University, who wrote an accompanying commentary, said more research is needed to find out more about who was quitting their drugs — sick people, or perhaps those who really didn’t need the medication.
“The actual impact on health is a big question mark,” she said.
Deverka said those studies are under way, and in the meantime, Medco would advise employers to take a more incremental approach when making changes to their health benefits.
Susan Pisano, a spokeswoman for AAHP-HIAA, a health industry group, said tiered plans have given broad access to prescription drugs to millions of Americans. She noted that the study does not take into account monitoring programs that make sure patients are taking critical drugs.
Gary Claxton of the Kaiser Family Foundation said patients should ask their doctor about generics or lower-costing alternatives when their benefits change.
“Make sure your physician knows that one drug versus another has a big consequence to you — particularly if it’s something you’re going to be taking for a long period of time,” he said.