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High Co-Pays Keeping Chronically Ill From Their Meds
By Amanda GardnerHealthDay Reporter
April 27, 2009
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MONDAY, April 27 (HealthDay News) — Rising co-pays may be keeping Americans with chronic illnesses from get the potentially lifesaving medications they need, a new study finds.
The problem may be symptomatic of rising health care costs in general and, according to Dr. Matthew D. Solomon, lead author of a study in the April 27 issue of the Archives of Internal Medicine, it's likely to get worse as the economy unravels.
"As people's budgets are tightened, spending across all categories — food, clothes, medicines — will be trimmed," said Solomon, who is a medical resident at Stanford University School of Medicine and a consultant with the nonprofit research group the Rand Corporation.
"This study comes in the midst of a national discussion about how to
control health care costs. A major focus is better management of care
for those with chronic conditions," added Carol Pryor, policy director of The Access Project in Boston.
With rising prescription-drug costs, health plans have been passing more of their cost onto consumers, often in the form of higher co-pays.
But the new findings "suggest that increasing cost-sharing for this vulnerable group [of chronically ill patients] is counterproductive — we need to make it easier for people with chronic illnesses to follow a treatment regimen to avoid greater costs for untreated disease later on," Pryor said.
Previous studies have shown that this practice has led to pared-down drug usage. One recent paper found that veterans' adherence to medication dropped more among veterans who had to make co-payments that increased in 2002, versus those who had no co-pays. Those making co-pays were also three times more likely to be without medication for more than three months.
The authors of this study looked specifically at why this phenomenon is occurring by delving into the records of more than 17,000 patients in 31 different health plans to track any delays between first diagnosis and when the patient started their medication.
All patients were newly diagnosed with hypertension, diabetes or high cholesterol between 1997 and 2002.
Previous studies have linked not taking or skimping on medicines to worse health outcomes. "If you do not treat these illnesses, you will end up with a higher rate of heart attack and stroke," Solomon said.
Five years post-diagnosis, 21.5 percent of patients with hypertension had still not initiated drug therapy, and neither had 36 percent of people with high cholesterol or 32.5 percent of those with diabetes.
Crunching the numbers further, the team found that as co-pay amounts doubled, the percentage of patients who had started their medications dropped. For example, five years after their diagnosis, about 82 percent of people with hypertension had begun taking the drugs they needed to get their blood pressure under control, versus only about 66 percent of those whose co-pays were twice as much.
People who had never before taken prescription medicines were even less likely to fill their new prescriptions, the study found.
One strategy to ameliorate the problem could be to stratify co-pays depending on the specific drugs or severity of the condition. "Do we care if somebody has a high co-pay for Viagra? Maybe not as much as if they have a high co-pay for a diabetes medication," Solomon said.
Also, people who generally don't like taking medication tend to be extra-sensitive to co-payments, the study found. This group might respond well to a reduction in these payments, Solomon said.
Other experts felt that the consumer could themselves counteract, at least partially, the burden of rising co-pays.
"People should shop for drugs they way they shop for groceries," said John Goodman, founder and president of the National Center for Policy Analysis (NCPA), a free-market think tank in Dallas. Also, "some drugs can be split, so, by buying larger pills and splitting them, you can cut costs in half," he reasoned.
"Sometimes, doctors give patients free samples, and when they go to refill, that's not an inexpensive drug on Walmart's $4 list but a costly drug companies are trying to promote," added NCPA senior fellow Devon M. Herrick. "Patients who understand options can check for alternative drug treatments or ask if there are therapeutic options."
And another expert turned the focus to physicians.
"Overall, this [study] is more of a commentary about the delivery of primary care services, not cost-sharing," said Greg Scandlen, founder of the nonprofit advocacy group Consumers for Health Care Choices. "I'm just shocked that doctors are not paying attention to what their own patients are doing, that five years later, their patients are not taking the drugs prescribed."
More information
There's more on prescription drug costs at the Kaiser Family Foundation.
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This news article was provided through partnership with HealthDay — News for Healthier Living. Copyright ©2012 HealthDay. All Rights Reserved.
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Comments (12 comments)
Add your commentI agree with the article. Due to recent surgery I am unable to work and am now receiving SSDI which has caused issues with my medications because I can't afford the medications I was taking. My insurance basis my co-pay on a Tier system. Some of the medications I need to take had to be changed so I could afford them but I suffer side effects from them. Others I have had to quit taking entirely because I can't afford them. It really is dreadful that people who have sever medical issues have to give up their medications and risk suffering either side effects or possible other medical conditions because the drug companies charge so much for their medications. I also think feel insurance companies should look at the health issues they are causing by refusing to pay for the drugs based on a Tier system.
My wife has diabetes and even with the great health care we have with my job, our out of pocket expense exceeds $5,000 dollars a year. My wife also has psoriatic arthritis and the shots cost in excess of 1,000 dollars per month. I don't know how people without insurance can do it.
I also take Januiva. I could not afford it either because I had no insurance. I contacted the company and they have helped out a lot. I have done this with other meds also. Most med companies are great about this but you have to qualify. My doctor also gives samples to people who can't afford them. When I lost my insurance I had no where to turn so I started wenning myself of some of my meds and scraped by. I was to proud to ask for help from anyone. I soon found that some of the meds especially my diabetic meds, my doctor helped me out alot, you need to be truthful with you doctors when things like this happens.
I happen to also be an individual on a fixed income and require medication not only for diabetes but high chlosterol, hypertension, bladder issues, and mental health issues. I took my prescriptions two of my prescriptions to Wal Mart to have filled and they were generic but not on their list. One prescription was going to cost me $124 which I could not afford. The other cost me $30 which left me with no funds for over two weeks.
I am also on Juanvia and I cannot take a generic, there are other medications I have to take that are not generic because I do not respond well to the generic or they don't have a generic. Even with medical insurance these drugs cost me $100 each co-pay. Just how are people suppose to keep physically and mentally well when the costs of medications are so high. Why is it narcotics are cheaper than medications that keep individuals out of the hospital?
I have to on a monthly basis decide what medical treatment I will get and what medications I will purchase and there are times I cannot do what is necessary to keep me healthy. I also recently had an extensive neck fusion due to arthritis.
I am not generally a person who whines but our health system is horrible. I live in the State of Washington and because the government cannot properly budget themselves one thing they are going to cut is medical services to low income individuals. Please tell me what is wrong with this picture?
Maybe the doctors and hospitals should lower what they charge-My doctor bills my insurance $12 for testing my blood sugar in his office. When I was hospitalized a simple tylenol cost $8. Ridiculous. No wonder the insurance companies can't afford to insure us anymore. Isn't that similiar to price gouging. If it's not illegal, it sure should be.
I am taking Jauniva for my diabetes, my first order was 150.00 for 90 days my sec.order was 175 for 90 days. At this rate I am either going to ask for a generic which my doctor doesn't want to give me cause I am doing so well on my meds. So what will the out come be. $ wise in the next 3 mo. when I need to get my med again. Will it go up another $25 till my medicare montly pay check say's to bad but I no longer get the med's I need.?
It is a terrible choice to face. I have been in situations where I could not afford the medicine I needed. Our health care system is desperate for solutions. Thanks for clarifying your focus… j
Sorry, I didn't mean to solely focus on the data. The topic of this story is definitely concerning. It is obvious that the more expensive medications are, the more people will choose to go without it. And that is a terrible choice.
I guess I felt some frustration that the article didn't indicate if they controlled for the fact that some diabetics are diagnosed but not prescribed drugs.
Research is often incomplete on statistics generally. But the article did succeed in getting the point across that health care is seriously lacking in reaching a large number of those who critically need attention. It is a depressing situation for sure when people who need medical care cannot solve their delemma in getting it.
I agree that more info would be nice, but the fact remains that it is not easy or even reasonable for many to properly medicate and care for themselves because of increased costs of insurance, increased deductibles and loss of insurance and inability to pay.
I agree with John's question on the data. But what should also be mentioned is those who pay out of pocket and cannot afford their meds.
I wonder about the accuracy of their numbers. 32.5 percent of people diagnosed with diabetes haven't started drug therapy five years later.
The story makes it sound like this is the patient choosing to not to take prescribed drugs. But certainly some percentage of newly diagnosed diabetics are never prescribed drugs. They are taught to control it with diet and exercise. I wish it had a little more information about how they gathered the data.