A study in the Journal of the American Medical Association suggests that HMOs' increased use of cost-sharing to soften prescription drug expenses may have actually increase overall medical costs over the long term. The authors contend that increased out-of-pocket prescription drug spending forces some members to stop taking medications that would otherwise prevent illness.
Rising drug prices have led many health plans and pharmacy benefit managers to institute higher copayments and deductibles and to lower benefit caps. The intent often is to discourage patients from taking medications that may not be medically necessary — but as the authors point out, that assumes informed decision-making on the part of patients.
The study examined the impact of Quebec's decision to implement a universal drug benefit in 1996. To fund the program, the province introduced a deductible and a 25-percent copayment for everyone; previously, prescription drugs had been available at no cost to the elderly and to low-income residents.
Analyzing claims data, the authors found that use of essential drugs dropped 9 percent in the elderly, and 14 percent by low-income residents. In both groups, adverse effects and emergency visits associated with reduced adherence to prescription regimens more than doubled.
From this, the authors speculate that short-term pharmacy savings may be much smaller than the added cost of treating illness down the road.
The government did achieve its aim, as use of less-essential prescription drug products dropped 15 percent among older people and 22 percent in the low-income group. There were few adverse effects associated with these reductions.