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
http://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
at http://www.cdc.gov/nccdphp/overview.htm, accessed October 20, 2006.
8. American College of Physicians. "Costs and Quality Associated With
Treating Medicare Patients With Multiple Chronic Diseases." Available at
http://www.acponline.org/hpp/costs_quality.pdf. 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
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