NCPA - National Center for Policy Analysis


April 29, 2009

Rising co-pays may be keeping Americans with chronic illnesses from get the potentially lifesaving medications they need.  The problem may be symptomatic of rising health care costs in general and is likely to get worse as the economy unravels, says a new study in the Archives of Internal Medicine.

Researchers looked specifically at why this phenomenon is occurring by delving into the records of more than 17,000 patients in 31 different health plans to track any delays between first diagnosis and when the patient started their medication.  All patients were newly diagnosed with hypertension, diabetes or high cholesterol between 1997 and 2002:

  • As co-pay amounts doubled, the percentage of patients who had started their medications dropped.
  • For example, 5 years after their diagnosis, about 82 percent of people with hypertension had begun taking the drugs they needed to get their blood pressure under control, versus only about 66 percent of those whose co-pays were twice as much.
  • People who had never before taken prescription medicines were even less likely to fill their new prescriptions.

Some strategies to ameliorate the problem include stratifying co-pays depending on the specific drugs or severity of the condition and turning the focus on physicians.  However, other experts feel that the consumer could themselves counteract the burden of rising co-pays:

  • Some drugs can be split, so, by buying larger pills and splitting them, you can cut costs in half, says John C. Goodman, President and CEO of the National Center for Policy Analysis.
  • Sometimes, doctors give patients free samples, and when they go to refill, that's not an inexpensive drug on Wal-Mart's $4 list but a costly drug companies are trying to promote, says NCPA senior fellow Devon Herrick.
  • Further, patients who understand options can check for alternative drug treatments or ask if there are therapeutic options.

Source: Amanda Gardner, "High Co-Pays Keeping Chronically Ill From Their Meds," Health Day, April 27, 2009; based upon: Matthew D. Solomon et al., "Cost Sharing and the Initiation of Drug Therapy for the Chronically Ill," Archives of Internal Medicine, Vol. 169, No. 8, April 27, 2009.

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