|Higher Co-Payments Discourage Patients From Starting Drug Treatment
Patients newly diagnosed with hypertension, diabetes or
high cholesterol are significantly more likely to delay initiating
recommended drug treatment if they face higher co-payments for
medications, according to a new RAND Corporation study.
The delay was significant across all conditions, but the
impact was largest among patients who had not previously used
prescription drugs, according to the study published in the Archives of
While several studies have established that higher drug
co-payments discourage some patients from taking their medications, the
new RAND Health study is the first to examine the impact higher
out-of-pocket costs have on patients who are beginning drug treatment
after being diagnosed with a chronic illnesses.
"Our study clearly shows that out-of-pocket costs reduce
patients’ willingness to start treatment for their chronic
illnesses," said Lead Author Dr. Matthew D Solomon, an adjunct
researcher at RAND, a nonprofit research organization. "It is
indisputable that avoiding treatment for these conditions will lead to
higher rates of heart attack and stroke."
The study included 272,474 retirees who received health
coverage from their former employers from 1997 to 2002 and were covered
by 31 different health plans. Researchers focused on 17,183 people from
this group who were newly diagnosed with diabetes, high blood pressure
or high cholesterol, examining their records to see when they began to
fill prescriptions for needed medications.
For each of the conditions, patients who had higher
out-of-pocket costs were less likely to start prescription drug therapy
compared to other patients in the study. For example, among those newly
diagnosed with high blood pressure, those starting drug treatment
within a year of diagnosis dropped from 55 percent to 40 percent when
their co-payment doubled. After five years, the difference was 82
percent to 66 percent, according to the study.
Similar differences were seen among those diagnosed for
the first time with diabetes and high cholesterol, according to
researchers. Patients starting drug treatment within a year of
diagnosis with high cholesterol dropped from 40 percent to 31 percent
when patients’ out-of-pocket costs doubled. After five years, the
difference was 64 percent to 54 percent.
Among patients with diabetes, those starting drug
treatment within a year of diagnosis dropped from 46 percent to 40
percent when co-pays doubled. After five years, the difference was 69
percent to 63 percent.
"Along with behavioral and lifestyle modification,
prescription drug therapy is the cornerstone of management for these
diseases," said Solomon, who is also a medical resident at Stanford
University. "If left untreated, each of these conditions will increase
a person’s risk for having a potentially fatal cardiovascular
event, such as a heart attack or stroke."
The study also showed that patients who had no
experience with medications were even less likely to begin recommended
drug treatment, an indication that some patients may have a preference
against medication use.
Solomon said the new RAND study holds implications for
policymakers and insurance officials interested in creating policies to
improve medication compliance and raise the quality of care.
In addition, it should highlight for physicians the
types of patients who may be most likely to ignore recommended drug
"Epidemiologic studies tell us that we do a terrible job
of treating patients with these conditions. Now we know one reason
why," Solomon said.
Address: RAND Corporation, 1776 Main St., Santa Monica, CA 90401; (310) 393-0411, www.rand.org.