Study Published in Journal of Occupational and Environmental Medicine
Investigates Relationship of Co-payments, Medication Adherence, and Health
Resource Utilization
PHILADELPHIA, May 12 /PRNewswire-FirstCall/ -- High prescription drug
co-payments are associated with lower medication adherence and higher total
healthcare costs, according to a new study published this month in the
Journal of Occupational and Environmental Medicine. The study, funded by
GlaxoSmithKline (NYSE: GSK), investigated the effects of varied co-payment
levels on oral diabetes medication adherence, health resource utilization,
and total health costs for PPG Industries employees, retirees, and
dependents.
In comparing medication adherence and healthcare costs for patients
with diabetes, PPG Industries, a global manufacturer and provider of
coatings, glass and chemical products, noted that those with lower
co-payments had better adherence to oral diabetes medicines, and averaged
$3116 less per year in total health care costs than those in the highest
co-payment group.
Poor medication adherence can be attributed to several factors.[1,2]
The effects of high prescription drug co-payments have been studied
extensively since they have often been used by employers and insurers in an
attempt to contain spiraling drug costs for chronic diseases, such as
diabetes, and to prevent individuals from seeking unnecessary medical
care.[3] Increasing co-payments has been shown to decrease use of
medications for chronic conditions.[4-6] Until recently, few studies have
investigated the relationship between co-payment level, adherence, and use
of subsequent health resources.
The Effects of Health Plan Co-payments on Adherence to Oral Diabetes
Medication and Health Resources Utilization was a 2-year retrospective
study. In it, PPG Industries analyzed the eligibility, medical, and
pharmacy claims data from 2052 employees, retirees, and dependents with
type 2 diabetes to determine the impact of different co-payment levels.
Using data from 2003-2005, individuals were grouped according to their
average monthly prescription co-payments: low ($0-9), medium ($10-19), or
high ($20+). Within these groups, individuals were then further divided by
age. This stratification [under 65 years (n=908) and those 65 years or
older (n=1144)] was necessary because for those individuals over 65,
healthcare coverage is provided in part by Medicare, therefore complete
cost data were not available.
The study was co-authored by Alberto M. Colombi, MD, (PPG Industries);
Kristina Yu-Isenberg, PhD and Julie Priest, MSPH (GSK).
Key Findings
Key findings of the study included:
-- High co-payments were associated with lower adherence to oral diabetes
medications for all patients regardless of age.
-- High co-payments were associated with higher total healthcare costs for
patients less than 65.
-- For those under 65, total healthcare costs for the low co-payment
group were 22% lower than the highest co-payment group, amounting to
$3116 per patient per year.
-- For those aged 65 or older, the risk for hospitalizations was 36% lower
among those in the lowest co-payment group.
The current study complements the results of earlier studies from GSK's
Health Management Innovations team which indicate that increasing
prescription co-payments results in decreased medication adherence. These
studies, read in the context of the body of literature on medication
adherence, suggest that value-based benefit design can lead to better
adherence -- and better outcomes for both patients and employers.
"We have seen in earlier studies how increasing co-payments negatively
affects patient medication adherence. With this study, we've shown that
high co-payment levels and low adherence increase the use of other health
resources, leading to higher overall health costs," said Michael C. Sokol,
MD, MS, medical director for GSK's Health Management Innovations team. "Our
goal must be to develop health benefit strategies that improve the health
of patients -- which can lead to lower total healthcare costs."
Investing in Health Instead of Paying for Sickness
Today's greatest healthcare threats 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]
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.
"Clearly, adherence is a critical component of chronic disease
management, where patients have to play an active role in their own
treatment," said Alberto Colombi, MD, Corporate Medical Director, PPG
Industries. "One important way to enable active involvement is by providing
education and facilitating access to care."
"Additionally, the healthcare delivery system should focus on
prevention to keep people healthier, provide patients the right treatments
to maintain their health, and design benefit plans that invest in health
instead of paying for sickness," Dr. Colombi said.
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:
-- Overall medication adherence on health outcomes
-- Health management initiatives on adherence and health outcomes
-- Co-payment on diabetes medication adherence and HbA1c levels
-- Income and out-of-pocket cost on adherence and outcomes
Formal results of these studies will be announced as they are published.
To read the study, visit
http://www.joem.org/pt/re/joem/abstract.00043764-200805000-
00003.htm;jsessionid=LyGf1HCLwZmQNN4lvQGM9W5hYKrwL0pHT6RLbWWp51GmJyN0nNJ3!2
989 90308!181195629!8091!-1 (due to the length of the URL, please copy and
paste into browser)
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.
SOURCE GlaxoSmithKline
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Related links:
http://www.gsk.com
http://www.prnewswire.com/comp/801350.html/
CONTACT:
Michael McTigue of GlaxoSmithKline,
+1-215-751-7709
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