Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.
Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.
Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.
Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in the journal Health Affairs.
“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and his colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”
The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared with those of 49,801 fellow employees whose copayments were not changed (doi: 10.1377/hlthaff.2010.0808).
To measure medication adherence, the study's authors estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared with the total number of days in each month between January 2006 and December 2007.
Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared with controls. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with controls.
Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared with the control group, according to the investigators. The number of patients who were fully adherent rose by 20% immediately, compared with the control group.
This type of value-based benefit design can improve compliance, but physicians and policy makers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.
Cost definitely plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”
Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that the patients in Dr. Choudhry's study already were paying a reduced cost for their medications, and so “the effect may be diminished. If they did a study of someone paying $150 or $200 out of pocket for a medication and then bring that down to $15, they might see a greater effect,” he said in an interview.
Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “A lot of factors play into it,” Dr. Dickson said in an interview.
“Not making appointments, not going in for testing, not filling the prescription – all just go along with not being compliant with medications. What this shows us is, sometimes they just can't afford it.”