Cutting Copayments for Drugs Improves Compliance

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in one self-employed company.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;doi:10.1377/hlthaff.2010.0808).

To measure medication adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month during 2006-2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with the control group.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared to the control group, the investigators wrote. The number of patients who were fully adherent rose by 20% immediately, compared with controls.

This type of value-based benefit design can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. For a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

View on the News

Carrots and Sticks in Health Reform

One possible way to save health care dollars is to use tradeoffs in the form of higher cost-sharing for care deemed less essential, according to Marjorie Ginsburg.

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Ms. Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think.

If employers and insurers truly want to employ both the “carrot” of positive incentives and the “stick” of higher costs for services deemed lower-value, they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MS. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010[doi:10.1377/hlthaff.2010.0808]).

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in one self-employed company.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;doi:10.1377/hlthaff.2010.0808).

To measure medication adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month during 2006-2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with the control group.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared to the control group, the investigators wrote. The number of patients who were fully adherent rose by 20% immediately, compared with controls.

This type of value-based benefit design can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. For a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

View on the News

Carrots and Sticks in Health Reform

One possible way to save health care dollars is to use tradeoffs in the form of higher cost-sharing for care deemed less essential, according to Marjorie Ginsburg.

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Ms. Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think.

If employers and insurers truly want to employ both the “carrot” of positive incentives and the “stick” of higher costs for services deemed lower-value, they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MS. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010[doi:10.1377/hlthaff.2010.0808]).

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in one self-employed company.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;doi:10.1377/hlthaff.2010.0808).

To measure medication adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month during 2006-2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with the control group.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared to the control group, the investigators wrote. The number of patients who were fully adherent rose by 20% immediately, compared with controls.

This type of value-based benefit design can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. For a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

View on the News

Carrots and Sticks in Health Reform

One possible way to save health care dollars is to use tradeoffs in the form of higher cost-sharing for care deemed less essential, according to Marjorie Ginsburg.

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Ms. Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think.

If employers and insurers truly want to employ both the “carrot” of positive incentives and the “stick” of higher costs for services deemed lower-value, they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MS. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010[doi:10.1377/hlthaff.2010.0808]).