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Prescription use down when co-payments rise

Sharp increases in co-payments for prescription drugs may cause people to cut their use of medications for chronic diseases like asthma and diabetes, a study released Tuesday said.
/ Source: Reuters

Sharp increases in out-of-pocket prescription drug payments could cause people to cut use of medications for chronic diseases like asthma and diabetes and may lead to more costly medical problems, a study released Tuesday said.

Doubling co-payments, the amount paid by patients, was linked to reduced use of eight types of drugs for problems like asthma, depression and allergies, according to a study by a unit of the nonprofit research organization RAND Corp.

Spending on outpatient prescription drugs, along with hospital and doctor costs, is rising at several times the rate of inflation.

To cut drug spending, insurance companies raised co-payments, had patients order prescriptions by mail and insisted that patients take lower-priced generic drugs.

Average co-payments rising
Some require patients to pay more for other medicines than they do for the cheaper generic drugs. Between 2000 and 2003, the average co-payment in these systems rose 46 percent to $19 for drugs on which the insurer has negotiated a lower price with the manufacturer and 71 percent to $29 for drugs where no such deal had been struck.

The average co-payment for generic drugs rose 28 percent to $9.47 over that period, according to data compiled by the Kaiser Family Foundation.

“Raising co-payments is a blunt tool for changing people’s use of prescription medicine,” said Dana Goldman, lead author of the study published in the Journal of the American Medical Association and director of health economics at RAND Health.

“If we want to change the patterns of drug use so that we don’t adversely affect patients’ health, that will require more sophisticated benefit designs.”

Patients were more likely to cut back on prescription drugs that can be replaced with over-the-counter drugs that treated symptoms, rather than the underlying disease, the study said.

When co-payments rose, prescription antihistamine use dropped 44 percent and use of prescription anti-inflammatory drugs fell 45 percent, said the study, which analyzed data from pharmacy and medical claims in 1997 to 2000 for 30 large U.S. employers and 52 health plans. The data covered  528,969 beneficiaries, aged 18 to 64 years.

But antidiabetic drug use fell 25 percent and use of antidepressants and drugs to bring down high blood pressure both fell 26 percent, the study said. Prescription drug use for asthma fell 32 percent, anti-ulcer drug use fell 33 percent and cholesterol lowering drugs fell 34 percent, said the study, which was funded in part by drug maker Merck & Co Inc.

ER visits increased
But patients also make some choices on which prescription drugs they reduce, the researchers said. For example, patients diagnosed with high blood pressure reduced the use of other drugs by 27 percent when co-payments doubled, but only cut blood-pressure medicine by 10 percent.

The study showed evidence that higher co-payments lead to increased emergency room visits and hospital stays for conditions like diabetes and asthma, the study said.

“Our findings raise concern that co-payment increases could lead to adverse health consequences, at least for individuals with some conditions,” the authors said.