Health Care Costs and Financing

High prescription drug copays may result in patients delaying therapy

Health insurance plans are making patients share more in the cost of care, such as increasing copays for prescription drugs. However, higher cost sharing results in patients waiting longer to start taking their newly prescribed medications, concludes a new study. Researchers studied 17,183 patients with newly diagnosed high blood pressure, diabetes, or high cholesterol. All were receiving employer-provided drug coverage from 31 different health plans. The researchers measured the time from disease diagnosis until the start of drug therapy.

Higher copayments were associated with delays in the start of therapy for all three medical conditions. This was most evident when copayments were doubled. In this case, the predicted proportion of patients starting medication fell from 54.8 percent to 39.9 percent at 1 year. At 5 years, the proportion dropped from 81.6 percent to 66.2 percent. A patient's rate of therapy initiation and sensitivity to copayment increases was strongly associated with their history of prescription drug use.

Among patients with high blood pressure, those who did not have any experience taking prescribed medications in the past tended to start their therapy later. They were also more sensitive to increased levels of cost sharing. Physicians need to be aware of these findings when prescribing drugs for patients newly diagnosed with chronic disease, especially those new to taking medications, caution the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13869).

See "Cost sharing and the initiation of drug therapy for the chronically ill," by Matthew D. Solomon, M.D., Ph.D., Dana P. Goldman, Ph.D., Geoffrey F. Joyce, Ph.D., and José J. Escarce, M.D., Ph.D., in the April 27, 2009 issue of the Archives of Internal Medicine 169(8), pp. 740-748.

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