New Study Indicates Decreasing Prescription Copayments Results in Increased Adherence for Patients with Chronic Disease
New Study Indicates Decreasing Prescription Copayments
Results in Increased Adherence for Patients with Chronic
Diseases
Tuesday January 8, 8:53 am ET
Study published in Health Affairs highlights large employer's efforts to
develop a healthier workforce by removing barriers to treatment
PHILADELPHIA, Jan. 8 /PRNewswire-FirstCall/ -- Removing economic barriers to
treatment for chronic conditions encourages patients to remain on recommended
therapies according to a new study published today in the January/February 2008 issue
of Health Affairs. The study, funded, in part, by GlaxoSmithKline (NYSE: GSK - News),
investigated the impact on medication adherence of reducing prescription copayments --
in addition to existing disease management programs -- for employees of a leading
service industry company.
Although a lack of medication adherence can be attributed to several factors,(1,2) the
effects of high prescription drug copayments have been studied extensively since they
have often been used by employers and insurers to control drug expenditures(3).
Increasing copayments has been shown to decrease use of medications for chronic
conditions.(4-6) But few studies have assessed the impact of decreasing copayments for
important prescription medications.
The Impact of Decreasing Copayments on Medication Adherence in the Context of a
Disease Management Program was a 12-month study in which the company, a global
service provider, decreased copayments for the following medicines used to treat
common chronic diseases:
-- Heart Disease: angiotensin converting enzyme (ACE) inhibitors,
angiotensin receptor blockers (ARBs), and beta-blockers
-- Diabetes: medications including oral therapies and insulin
-- High Cholesterol: statins
-- Asthma: inhaled corticosteroids
Copayment rates for generic medications were reduced from $5 to $0; copayments for
branded drugs were cut in half. A similar employer with identical disease management
offerings and similar but stable copayments served as a control group.
The study was coauthored by Michael E. Chernew, PhD (Harvard University); A. Mark
Fendrick, MD and Allison B. Rosen, MD, ScD (University of Michigan); Mayur Shah, MA,
Arnold Wegh, MS, Stephen Rosenberg, MD, MPH, and Iver A. Juster, MD (Active Health
Management); and Michael C. Sokol, MD, MS and Kristina Yu-Isenberg, PhD, RPh
(GSK). Doctors Fendrick, Rosen, and Chernew are members of the University of
Michigan Center for Value-Based Insurance Design.
Key Findings
The study investigated the impact of lowering copayments both on the rates of
adherence and non-adherence for selected chronic medications. Both adherence and
non-adherence were determined based upon the ratio of eligible days each patient was
in possession of his or her medicine.
Several key findings resulted:
-- There was a statistically significant improvement in adherence for
heart disease, diabetes, and high cholesterol.
-- The results were achieved in addition to the effects of existing
disease management programs.
-- Value based insurance design programs can effectively increase
adherence to important medications and complement existing disease
management programs.
There was a small positive result for inhaled corticosteroids for the treatment of asthma,
which was not, however, statistically significant. The authors note that this finding
reflects the difficulty of measuring adherence for this class of drugs -- there are multiple
doses in a single inhaler as opposed to the other medication classes, which more readily
allowed individual doses to be counted.
The current study complements the results of an earlier study from GSK's Health
Management Innovations team, which indicated that increasing prescription copayments
results in decreased medication adherence. These studies, taken together with the
literature on medication adherence, suggest that value based benefits can lead to better
adherence which may lead to better outcomes for both patients and employers.
"We saw in the earlier study the detrimental effect of increasing copayments on patient
medication adherence. Now with this study, we are able to show that removing
economic barriers to medication can positively affect patient behavior," said Michael C.
Sokol, MD, MS, medical director for GSK's Health Management Innovations team.
Good Health is Good Business
More often than not, today's greatest healthcare problems are chronic conditions which
require ongoing, patient-centered management. In fact, $3 of every $4 spent on
healthcare in the US(7) goes to treating the 45% of Americans with at least one chronic
disease.(8) As well, according to the Milken Institute, the seven most common chronic
diseases cost the US economy $1 trillion each year -- including both direct and indirect
costs. That figure is expected to reach $6 trillion each year by the middle of the century if
unchecked.(9)
Poor adherence to a medication regimen is a serious problem, especially for those with
chronic diseases, contributing to substantial worsening of disease, complications, death,
and increased healthcare costs.(10) While employers have often implemented strategies
of shifting costs onto the patient, this is only a short-term economic fix. To lower overall healthcare costs and improve the health of patients, the focus must be on the real
problem -- chronic diseases.
"We must encourage patients to take medications as prescribed for these chronic
conditions, and encourage employers to support the health management efforts of their
workers," said Dr. Mark Fendrick. "As a nation, we must look at the healthcare
continuum, focusing on prevention to keep people healthier, giving patients the right
treatments to maintain their health, and continuing the search for new cures."
GSK's Health Management Innovations team is also analyzing the results of several
other studies investigating potential factors affecting patient compliance, including
assessing the impact of:
-- copayment level on specific outcomes such as Hba1c levels for diabetic
patients
-- income on initial copayment levels and increases in copayment levels
-- implementing a consumer-directed health plan
-- implementing a pay-for-performance initiative
Formal results of these studies will be announced as they are published.
To hear more about this study, visit
www.med.umich.edu/opm/newspage/2008/drugcopay.asx.
About GlaxoSmithKline
GlaxoSmithKline, one of the world's leading research-based pharmaceutical and health
care companies, is committed to improving the quality of human life by enabling people
to do more, feel better, and live longer.
1. Haynes RB, Yao X, Degani A et al. Interventions to enhance medication adherence.
Cochrane Database Syst Rev. 2005:CD000011.
2. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to
medication prescriptions: scientific review. JAMA. 2002;288:2868-2879.
3. Kaiser Family Foundation and Health Research and Educational Trust. Annual
Surveys of Employer-Sponsored Health Benefits, 2000-2005.
4. Gibson TB, Ozminkowski RJ, Goetzel RZ. The effects of prescription drug cost
sharing: a review of the evidence. Am J Manag Care. 2005;11:730-740.
5. Lexchin J, Grootendorst P. Effects of prescription drug user fees on drug and health
services use and on health status in vulnerable populations: a systematic review of the
evidence. Int J Health Serv. 2004;34:101-122.
6. Goldman DP, Joyce GF, Escarce JJ et al. Pharmacy benefits and the use of drugs by
the chronically ill. JAMA. 2004;291:2344-2350.
7. CDC, "Chronic Disease Overview: Costs of Chronic Disease," available at
http://www.cdc.gov/nccdphp/overview.htm, accessed October 20, 2006.
8. American College of Physicians. "Costs and Quality Associated With Treating
Medicare Patients With Multiple Chronic Diseases." Available at
http://www.acponline.org/hpp/costs_quality.pdf. Accessed September 18, 2007.
9. Devol R and Bedroussian A. An Unhealthy America: The Economic Burden of Chronic
Disease. Milken Institute. October 2007.
10. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-
497.
•
del.icio.us
digg
facebook