Health Insurance Plans
Discourage People From Taking Their Meds
Health insurance plans that encourage
Americans to use less expensive drugs may
actually discourage some people from taking
important medications altogether.
Researchers found that when patients were
forced to pay more for their medications under
"three-tiered" prescription drug
plans, they were more likely to stop taking the
drugs -- including needed ones for chronic
illnesses like heart disease.
In one of the first studies to show how
workers treated for chronic illnesses react to
changes in their prescription drug plans, lead
author Haiden Huskamp and her colleagues found
higher co-payments saved the insurance company
money, but often cost patients a lot more.
Co-payments are out-of-pocket costs that
consumers must pay in addition to their health
care premiums. Huskamp, of Harvard Medical
School, said sizable co-payment increases could
have "worrisome effects."
Nearly two thirds of U.S. workers with health
insurance -- the rate is as high as 80 percent
in some parts of the country -- are now covered
by three-tiered prescription drug plans,
designed to steer patients to lower-priced
medicines. Under the plans, generic drugs
require the lowest co-payment,
"approved" prescription drugs require
a higher co-pay, and consumers must pay even
more for medications not on the approved list.
The unidentified company in the study that
dramatically revised its prescription program
started charging $8 for each generic
prescription, $15 for "approved"
brand-name drugs and $30 for unapproved
medicine. Previously, the co-payment for all
prescriptions was $7.
People forced to switch to the new system
were nearly three times more likely to stop
taking their ACE inhibitors for blood pressure
than workers in a different company who
continued to pay $7 for prescription drugs not
on the approved list.
Twice as many stopped taking their
cholesterol-lowering drugs and the number who
gave up their medicine to relieve excess stomach
acid also rose significantly.
Insurance companies often get special deals
on drugs that make it to their
"approved" lists, also known as
formularies. How much insurance companies make
from those deals and how much of the savings is
passed on to consumers "remain highly
guarded industry secrets," said Cindy Parks
Thomas in a commentary in The New England
Journal of Medicine, where the study was
published.
Thomas, of Brandeis University in Waltham,
Massachusetts, said such programs "may
create a particular burden for persons with
lower incomes or chronic diseases."
At a second company that switched to a
three-tier system but kept co-payments lower,
far fewer workers stopped taking their
medications. In addition, the savings to the
insurance company and cost to consumers were far
less dramatic.
Under that plan, consumers were charged $6
for generic drugs and $12 for any brand-name
medicine. After the switch to a three-tier
system, patients were charged a $24 co-payment
for unapproved drugs. The New England Journal
of Medicine, December 4, 2003.
