New Study Indicates Decreasing Prescription Copayments Results in Increased Adherence...

New Study Indicates Decreasing Prescription Copayments Results in Increased
Adherence for Patients with Chronic Diseases
Study published in Health Affairs highlights large employer's efforts to
develop a healthier workforce by removing barriers to treatment

PHILADELPHIA, Jan. 8 /PRNewswire-FirstCall/ -- Removing economic barriers
to treatment for chronic conditions encourages patients to remain on
recommended therapies according to a new study published today in the
January/February 2008 issue of Health Affairs. The study, funded, in part, by
GlaxoSmithKline (NYSE: GSK), investigated the impact on medication adherence
of reducing prescription copayments -- in addition to existing disease
management programs -- for employees of a leading service industry company.
Although a lack of medication adherence can be attributed to several
factors,(1,2) the effects of high prescription drug copayments have been
studied extensively since they have often been used by employers and insurers
to control drug expenditures(3). Increasing copayments has been shown to
decrease use of medications for chronic conditions.(4-6) But few studies have
assessed the impact of decreasing copayments for important prescription
medications.
The Impact of Decreasing Copayments on Medication Adherence in the Context
of a Disease Management Program was a 12-month study in which the company, a
global service provider, decreased copayments for the following medicines used
to treat common chronic diseases:

-- Heart Disease: angiotensin converting enzyme (ACE) inhibitors,
angiotensin receptor blockers (ARBs), and beta-blockers
-- Diabetes: medications including oral therapies and insulin
-- High Cholesterol: statins
-- Asthma: inhaled corticosteroids

Copayment rates for generic medications were reduced from $5 to $0;
copayments for branded drugs were cut in half. A similar employer with
identical disease management offerings and similar but stable copayments
served as a control group.
The study was coauthored by Michael E. Chernew, PhD (Harvard University);
A. Mark Fendrick, MD and Allison B. Rosen, MD, ScD (University of Michigan);
Mayur Shah, MA, Arnold Wegh, MS, Stephen Rosenberg, MD, MPH, and Iver A.
Juster, MD (Active Health Management); and Michael C. Sokol, MD, MS and
Kristina Yu-Isenberg, PhD, RPh (GSK). Doctors Fendrick, Rosen, and Chernew are
members of the University of Michigan Center for Value-Based Insurance Design.
Key Findings
The study investigated the impact of lowering copayments both on the rates
of adherence and non-adherence for selected chronic medications. Both
adherence and non-adherence were determined based upon the ratio of eligible
days each patient was in possession of his or her medicine.
Several key findings resulted:

-- There was a statistically significant improvement in adherence for
heart disease, diabetes, and high cholesterol.
-- The results were achieved in addition to the effects of existing
disease management programs.
-- Value based insurance design programs can effectively increase
adherence to important medications and complement existing disease
management programs.

There was a small positive result for inhaled corticosteroids for the
treatment of asthma, which was not, however, statistically significant. The
authors note that this finding reflects the difficulty of measuring adherence
for this class of drugs -- there are multiple doses in a single inhaler as
opposed to the other medication classes, which more readily allowed individual
doses to be counted.
The current study complements the results of an earlier study from GSK's
Health Management Innovations team, which indicated that increasing
prescription copayments results in decreased medication adherence. These
studies, taken together with the literature on medication adherence, suggest
that value based benefits can lead to better adherence which may lead to
better outcomes for both patients and employers.
"We saw in the earlier study the detrimental effect of increasing
copayments on patient medication adherence. Now with this study, we are able
to show that removing economic barriers to medication can positively affect
patient behavior," said Michael C. Sokol, MD, MS, medical director for GSK's
Health Management Innovations team.
Good Health is Good Business
More often than not, today's greatest healthcare problems are chronic
conditions which require ongoing, patient-centered management. In fact, $3 of
every $4 spent on healthcare in the US(7) goes to treating the 45% of
Americans with at least one chronic disease.(8) As well, according to the
Milken Institute, the seven most common chronic diseases cost the US economy
$1 trillion each year -- including both direct and indirect costs. That figure
is expected to reach $6 trillion each year by the middle of the century if
unchecked.(9)
Poor adherence to a medication regimen is a serious problem, especially
for those with chronic diseases, contributing to substantial worsening of
disease, complications, death, and increased healthcare costs.(10) While
employers have often implemented strategies of shifting costs onto the
patient, this is only a short-term economic fix. To lower overall healthcare
costs and improve the health of patients, the focus must be on the real
problem -- chronic diseases.
"We must encourage patients to take medications as prescribed for these
chronic conditions, and encourage employers to support the health management
efforts of their workers," said Dr. Mark Fendrick. "As a nation, we must look
at the healthcare continuum, focusing on prevention to keep people healthier,
giving patients the right treatments to maintain their health, and continuing
the search for new cures."
GSK's Health Management Innovations team is also analyzing the results of
several other studies investigating potential factors affecting patient
compliance, including assessing the impact of:

-- copayment level on specific outcomes such as Hba1c levels for diabetic
patients
-- income on initial copayment levels and increases in copayment levels
-- implementing a consumer-directed health plan
-- implementing a pay-for-performance initiative

Formal results of these studies will be announced as they are published.
To hear more about this study, visit
www.med.umich.edu/opm/newspage/2008/drugcopay.asx.

About GlaxoSmithKline
GlaxoSmithKline, one of the world's leading research-based pharmaceutical
and health care companies, is committed to improving the quality of human life
by enabling people to do more, feel better, and live longer.
1. Haynes RB, Yao X, Degani A et al. Interventions to enhance medication
adherence. Cochrane Database Syst Rev. 2005:CD000011.
2. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient
adherence to medication prescriptions: scientific review. JAMA.
2002;288:2868-2879.
3. Kaiser Family Foundation and Health Research and Educational Trust.
Annual Surveys of Employer-Sponsored Health Benefits, 2000-2005.
4. Gibson TB, Ozminkowski RJ, Goetzel RZ. The effects of prescription drug
cost sharing: a review of the evidence. Am J Manag Care. 2005;11:730-740.
5. Lexchin J, Grootendorst P. Effects of prescription drug user fees on
drug and health services use and on health status in vulnerable populations: a
systematic review of the evidence. Int J Health Serv. 2004;34:101-122.
6. Goldman DP, Joyce GF, Escarce JJ et al. Pharmacy benefits and the use
of drugs by the chronically ill. JAMA. 2004;291:2344-2350.
7. CDC, "Chronic Disease Overview: Costs of Chronic Disease," available here, accessed October 20, 2006.
8. American College of Physicians. "Costs and Quality Associated With
Treating Medicare Patients With Multiple Chronic Diseases." Available here. Accessed September 18, 2007.
9. Devol R and Bedroussian A. An Unhealthy America: The Economic Burden of
Chronic Disease. Milken Institute. October 2007.
10. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med.
2005;353:487-497.
SOURCE GlaxoSmithKline

Michael McTigue of GlaxoSmithKline, +1-215-751-7709