Posted on: Saturday, May 29, 2004

Even insured skimp at pharmacy

By Jane E. Allen
Los Angeles Times

Co-payments for prescription drugs may seem like a relatively minor expense; after all, many people must foot the entire bill for their medicine. But raising those payments, especially for folks who take several medications a day, can have a dramatic effect on even the privately insured.

Doubling out-of-pocket expenses for medications reduces the use of drugs for such chronic ailments as diabetes, asthma and ulcers by as much as 23 percent, researchers found. In some cases, that can imperil a patient's health.

"Employers who are trying to save money should be very careful about jacking up co-pays for certain illnesses," said study author Dana Goldman, director of health economics at Rand Health in Santa Monica, Calif. "It may end up costing them more in the long run, because people will be spending more on ER visits and hospitalizations."

By now, stories of fixed-income seniors who must choose between food and expensive medications have been told many times. But Rand Corp. researchers focused on what happens when medication bills go up for working-age consumers with prescription benefits.

The researchers analyzed pharmacy and medical claims from 1997 to 2000 for 30 large employers that insured more than half a million people through 52 health plans. They reviewed the effects of higher co-payments in the eight most widely prescribed drug classes. Overall, they found the greatest reductions in use of the nonsteroidal anti-inflammatories, 45 percent, and antihistamines, 44 percent. But these drugs, which relieve symptoms instead of underlying illness, are taken only occasionally.

Researchers were most concerned about potential health consequences among patients diagnosed with such chronic illnesses as diabetes, asthma, ulcers or gastrointestinal reflux disease, high cholesterol, high blood pressure and depression — patients whose health is most likely to improve with prescription therapy.

Among Type 2 diabetics who depend on oral medications, such as metformin (Glucophage), rosiglitazone (Avandia) or glyburide (Micronase) to control blood sugar, medication use fell by 23 percent. Such patients might have skipped pills, not filled prescriptions or gone off the medications, Goldman said.

The researchers analyzed the consequences of doubling average co-payments from $6.31 to $12.62 for a month's supply of a generic drug and from $12.85 to $25.70 for a brand-name drug.

Reporting in the current issue of the Journal of the American Medical Association, the researchers noted that among those with diabetes, asthma and stomach acid disorders, visits to emergency rooms increased 17 percent and hospital stays rose 10 percent.