NEW YORK (Reuters Health) Jul 03 - A rise in prescription drug cost sharing - which refers to pharmacy co-payments - is tied to a drop in drug spending and the use of pharmacies, according to a review of published studies. However, higher cost sharing may, in some cases, lead to increased use of expensive medical services, the results suggest.
"The evidence here...suggests that for each 10% increase in cost sharing, overall prescription drug spending decreases by 2% to 6%, depending on class of drugs and patient condition," lead author Dr. Dana P. Goldman, from RAND Corporation in Santa Monica, California, and colleagues note.
The goal of the present review, which appears in the Journal of the American Medical Association for July 4, was to determine how cost-sharing features of prescription drug benefits are associated with prescription drug use, use of non-pharmaceutical services, and health outcomes. A search of PubMed identified 132 articles relevant to this topic.
As noted, as cost sharing increased, drug treatment rates dropped, drug adherence worsened, and drug discontinuation rates rose. The reduction in drug use associated with a benefit cap is in accordance with other cost-sharing factors, the authors point out.
At the same time, for certain chronic conditions, such as heart failure, diabetes, and lipid disorders, higher cost sharing was linked to greater use of medical services.
The authors note that data is lacking to support the contention that low-income groups are more sensitive than others to increased cost sharing.
"The challenge for public and private plans is to make patients more sensitive to the cost of treatment without encouraging them to forgo cost-effective care," the investigators conclude. "This requires knowing how patients respond to difference incentives and cataloging the net benefits of alternative therapies, not only for health, but also for current and future healthcare costs, productivity, and patient utility."
JAMA 2007;298:61-69.
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