Higher Prescription Drug Copayments May Limit Use, Study Finds
Employees whose prescription drug copayments are increased under a tiered system in employer-sponsored health insurance plans may stop filling their prescriptions, according to a study published Thursday in the New England Journal of Medicine, the Boston Herald reports (Heldt Powell, Boston Herald, 12/4). The study, conducted by researchers at Harvard Medical School and pharmacy benefits manager Medco Health Solutions, analyzed data on more than 60,000 employees and dependents enrolled in health plans at two large, unnamed companies that implemented a tiered drug benefit between 1999 and 2001 (Forelle, Wall Street Journal, 12/4). Researchers compared the prescription drug usage at those two companies with a group of enrollees covered by the same insurer who did not experience a copay change (Huskamp et al., New England Journal of Medicine, 12/4). The first employer, with about 55,000 hourly employees, changed from a $7 flat copay for all prescriptions to a system in which employees paid $8 for generic prescriptions, $15 for preferred brand-name drugs and $30 for non-preferred brand-name drugs. The second employer, with 11,600 salaried employees, added a copay of $24 for non-preferred brand-name drugs to its existing two-tiered system of $6 copays for generic drugs and $12 for preferred brand-name drugs. Researchers looked at usage of ACE inhibitors, which treat high blood pressure and heart failure; proton pump inhibitors, which treat acid reflux disease; and statins, which reduce cholesterol levels.
Researchers found that employees at the first employer, which implemented a larger copay hike, were more likely than those at the second employer to stop filling prescriptions in the highest-cost tier when the drug plans changed. At the first employer, about 16% of employees stopped filling prescriptions for ACE inhibitors, compared with 6% in the comparison group that did not experience copay hikes; 21% stopped filling statin prescriptions, compared with 11% in the comparison group; and 32% stopped filling acid reflux treatments, compared with 19% of the comparison group (Nano, AP/Las Vegas Sun, 12/4). For those treatments, the percentage of employees at the first company who switched to a lower-cost drug ranged from about 35% to 49%, the study found (Wall Street Journal, 12/4). At the second employer, which implemented a more modest copayment increase, about 8% of employees stopped filling prescriptions for ACE inhibitors, compared with about 16% in the comparison group; about 9% discontinued filling statin prescriptions, compared with 4% in the comparison group; and almost 18% stopped filling acid reflux drugs, compared with 19% in the comparison group. Among those treatments, the percentage of employees at the second company who switched to a lower-cost drug ranged from about 18% to 49% (New England Journal of Medicine, 12/4). According to the Journal, the study's authors note that it could be medically appropriate for people to stop taking proton pump inhibitors in some cases, but Harvard researcher and lead author Haiden Huskamp said that the patients who stopped taking statins are "a little more worrisome."
Under the first employer's prescription drug benefit change, employees paid 142% more for ACE inhibitors, 148% more for acid reflux treatments and 118% more for statins; the health plan's spending on those drugs decreased by 58%, 15% and 14%, respectively. Under the second employer's new system, employees' costs increased by 8% for ACE inhibitors, 5% for acid reflux and under 1% for statins (Wall Street Journal, 12/4). The health plan's spending decreased by almost 6%, 2% and less than 1%, respectively (New England Journal of Medicine, 12/4). Total spending on prescription drug costs, including both employee and employer contributions, did not change by a large margin, according to the study (AP/Las Vegas Sun, 12/4).
The findings "raise concern" about employees who stopped taking some medications under tiered payment systems, a decision that "may have jeopardized their health," the Journal reports (Wall Street Journal, 12/4). However, the researchers did not follow the employees to determine how their decisions affected their health, and they noted that more research is needed to determine potential negative side effects, the Boston Globe reports. In an accompanying editorial, Cindy Parks Thomas of Brandeis University wrote that "important questions remain regarding the effect of these formularies on patients' health outcomes." Huskamp said, "We definitely want to provide this information to employers, health plans and policy makers" (Kowalczyk, Boston Globe, 12/4). He added that the study does not indicate that "three-tier systems are bad. It's how you structure it and the magnitude of the changes" (Boston Herald, 12/4). Dr. Patricia Deverka of Medco said it is "worrisome to see that people have stopped taking their medication." According to the Kaiser Family Foundation, nearly all employer-sponsored health insurance plans offer a prescription drug benefit, and almost 63% of those plans are three-tier plans, up from 27% in 2000 (AP/Las Vegas Sun, 12/4). An abstract of the study is available online. NPR's "Morning Edition" Thursday reported on the study. The segment includes comments from Deverka and Huskamp (Knox, "Morning Edition," NPR, 12/4). The full segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.