Co-Payment Increases Result in Gaps in Veterans' Prescription Usage

American Heart Association rapid access journal report:

Study highlights:

-- Cholesterol-lowering drug adherence drops with an increase in VA
prescription co-payments.

-- The odds of going for 90 straight days without medication was three times
higher among patients in the all co-payment group and twice as high in
patients in the some co-payment group when compared to the exempt group
(received prescriptions without a co-payment).

-- Researchers suggest charging lower co-payments for generic drugs than for
the brand-name prescription drugs or linking co-payments to the individual
patient's need.

DALLAS, Jan. 14 /PRNewswire-USNewswire/ -- Fewer veterans filled their
prescriptions for cholesterol-lowering drugs after an increase in co-payment
costs for prescription drugs, researchers report in Circulation: Journal of
the American Heart Association.

In February 2002, the Veterans Administration (VA) increased prescription
co-payments from $2 to $7 per 30-day drug supply.

To determine the impact of the co-payment increase on cholesterol-lowering
medication adherence, researchers examined the electronic records of 5,604
veterans treated at the Philadelphia Veterans Administration (VA) Medical
Center from November 1999 to April 2004.

They compared veterans in the all co-payment group and the some co-payment
group with veterans who were exempt from making prescription drug co-payments.
The all co-payment group paid co-pays for all drugs and the some co-payment
group paid co-pays only for drugs for non-service connected health problems
with out-of-pocket expenses capped at $840 per year.

Researchers analyzed the differences in cholesterol-lowering medication
adherence during the 24 months before and 24 months after the institution of
co-payments. Evidence of veterans having cholesterol-lowering medication 80
percent or more of the time were considered adherent.

Researchers found:
-- The number of patients who had medications available for more than 80
percent of the time declined by more than 19 percent in both the all
co-payment group and the some co-payment group. In comparison,
veterans
exempt from co-payments, used as controls in the study, had a decline
of
12 percent.
-- The odds of having a continuous gap without medications for more than
90
days was three times higher among patients in the all co-payment group
and twice as high in patients in the some co-payment group when
compared
to the exempt group.

"The increase in co-payments adversely impacted lipid-lowering medication
adherence among veterans," said Jalpa A. Doshi, Ph.D., lead author of the
study and research assistant professor of medicine at the University of
Pennsylvania School of Medicine. "Of even greater concern is our finding on
the similar adverse effect of the co-payment increase in veterans who are at
higher risk for coronary artery disease taking the medications for primary or
secondary prevention."

Statins and other cholesterol-lowering drugs have been shown to reduce the
risk of future coronary events and cardiovascular mortality in patients at
high risk, Doshi said.

"It is concerning to see that the increase in co-payments adversely affected
the use of these usually long-term medications, especially since the
prevalence of heart disease is higher in the VA population than in the general
population," Doshi said. "These weren't just short gaps interspersed between
lipid-lowering medication refills, but continuous gaps for 90 days or more."

The study did not look at the possible increase in use of medical care due to
the lack of cholesterol-lowering drugs. Other studies have shown that not
taking medications for chronic diseases increases healthcare costs.

"Policymakers need to realize that the one-size-fits-all approach in designing
cost-sharing policies can adversely impact high-risk patient groups," Doshi
said. "This seemingly small increase from $2 to $7 more than tripled the
out-of-pocket costs for veterans, who were more likely to have a lower income
than the patients in the private sector."

The VA should at least consider charging lower co-payments for generic drugs
than for the brand-name prescription drugs, Doshi said. "Right now the VA
charges a flat co-payment for a 30-day prescription, whether it is generic or
a brand-name drug. This is particularly relevant in the case of
lipid-lowering drugs such as statins, wherein two brand drugs became available
as generics in 2006 and are available at significantly lower prices."

She said a more-promising approach is a "value-based insurance design" method
that would link co-payments to the patient's need with lower co-payments for
drugs with higher expected therapeutic benefit and higher co-payments for
drugs with lower therapeutic benefit.

The co-payment was increased from $7 to $8 in 2006, and with present budget
constraints, it's likely that the co-payment will be further increased, Doshi
said.

The VA Center for Health Equity, Research and Promotion (CHERP), American
Heart Association Pharmaceutical Roundtable Award, Commonwealth of
Pennsylvania, the National Institute of Aging and the Penn Institute on Aging
funded the study.

Co-authors are: Jingsan Zhu, M.B.A.; Bruce Lee, M.D., M.B.A.; Stephen Kimmel,
M.D., M.S.C.E.; and Kevin Volpp, M.D., Ph.D. Individual author disclosures
are available on the manuscript.

Statements and conclusions of study authors that are published in American
Heart Association scientific journals are solely those of the study authors
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SOURCE American Heart Association

Cathy Lewis of the American Heart Association, +1-214-706-1396