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Fewer Prescriptions Being Filled

As Co-Pays Rise, Insurers, Employers Benefit, Patients Don't Get Drugs
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WebMD Health News

Oct. 10, 2002 -- Chances are, your co-pay for prescription drugs has gone up lately -- and if you're like an increasing number of Americans, you may have decided that you can no longer afford to take your medicine. As employers pass the rising cost of prescription drugs on to their employees, those employees may end up paying with their health.

A new analysis looked at employer health plans, employee co-pays (what they pay out of their own pockets), and the rising cost of healthcare spending.

The researchers looked at working adults because their drug costs account for 20-25% of their total healthcare expenses -- much higher than the 10% of the national healthcare budget spent on drugs. The study appears in the Oct. 9 issue of The Journal of the American Medical Association.

Researchers examined five years' worth of insurance claims for more than 400,000 adults aged 18-64 who worked for 25 large companies.

Health plans recently have tried to shave drug costs, which rose by double-digit rates in the last decade. Among other things, they have raised patient co-payments, created restrictive formularies (lists of acceptable drugs for particular conditions), and mandated generic drug substitution when possible.

Many plans now have multi-tiered formularies, in which co-pays are lowest for generic drugs and highest for name-brand drugs that have no generic substitute. The new analysis shows employer health plans substantially reduce their own costs when they increase employees' out-of-pocket expenses in single and multi-tier plans.

It also shows that as co-pays get bigger, patients fill fewer prescriptions, which raises a public health concern. In an accompanying editorial, Donald M. Steinwachs, PhD, of the Johns Hopkins Bloomberg School of Public Health writes that when people don't take their medicine, resulting health problems could land them in a doctor's office or emergency room. Costs for such care would wipe out any prescription drug savings.

Steinwachs says patients with a limited ability to pay for prescriptions usually don't have the right information when deciding which prescriptions to fill -- whether one drug is more essential than another. He calls for more efficiency in the healthcare system that would let doctors help patients make those decisions.

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